Provider Demographics
NPI:1912542945
Name:GREENHOLT, ISABELA ANA (PAC)
Entity Type:Individual
Prefix:
First Name:ISABELA
Middle Name:ANA
Last Name:GREENHOLT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ISABELA
Other - Middle Name:ANA
Other - Last Name:UGARTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-3110
Mailing Address - Fax:717-339-3108
Practice Address - Street 1:450 S WASHINGTON ST STE C
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2500
Practice Address - Country:US
Practice Address - Phone:717-339-3110
Practice Address - Fax:717-339-3108
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMU5682770363A00000X
PAOA005085363A00000X
PAMA061271363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103716444Medicaid