Provider Demographics
NPI:1760127112
Name:WADSWORTH, MICHAELA RACHELE (PA)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:RACHELE
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 NORTHERN PIKE STE 101
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2823
Mailing Address - Country:US
Mailing Address - Phone:412-683-2267
Mailing Address - Fax:
Practice Address - Street 1:4318 NORTHERN PIKE STE 101
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2823
Practice Address - Country:US
Practice Address - Phone:412-683-2267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-30
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical