Provider Demographics
NPI:1710315569
Name:WILMOTH, ANNE E
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:WILMOTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CLINTON CT
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3362
Mailing Address - Country:US
Mailing Address - Phone:814-333-8277
Mailing Address - Fax:814-333-6203
Practice Address - Street 1:280 CLINTON CT
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3362
Practice Address - Country:US
Practice Address - Phone:814-333-8277
Practice Address - Fax:814-333-6203
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056342363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP01510431OtherMEDICARE RAILROAD
PAP01510431OtherMEDICARE RAILROAD