Provider Demographics
NPI:1790177665
Name:WOLFRAM, ASHLEY (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WOLFRAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2400 CORPORATE EXCHANGE DR
Mailing Address - Street 2:STE 102
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-7651
Mailing Address - Country:US
Mailing Address - Phone:740-353-8661
Mailing Address - Fax:740-354-3254
Practice Address - Street 1:1711 27TH ST
Practice Address - Street 2:BRAUNLIN BUILDING SUITE 306
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2654
Practice Address - Country:US
Practice Address - Phone:740-353-8661
Practice Address - Fax:740-354-3254
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2023-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50.004296363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant