Provider Demographics
NPI:1861490302
Name:JOLLIFF-SCHILTZ, WENDY E (PA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:E
Last Name:JOLLIFF-SCHILTZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:E
Other - Last Name:JOLLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2142 N COVE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3895
Mailing Address - Country:US
Mailing Address - Phone:419-291-5318
Mailing Address - Fax:419-291-6430
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-5318
Practice Address - Fax:419-291-6430
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5001436363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074296Medicaid
OH0074296Medicaid
OH75901Medicare PIN
OH970018182Medicare PIN