Provider Demographics
NPI:1942895560
Name:WYLIE, ASHTYN (CNM)
Entity Type:Individual
Prefix:
First Name:ASHTYN
Middle Name:
Last Name:WYLIE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 ONEIDA VALLEY RD
Mailing Address - Street 2:STE 211
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2252
Mailing Address - Country:US
Mailing Address - Phone:844-764-2845
Mailing Address - Fax:
Practice Address - Street 1:5910 KIRKWOOD ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3048
Practice Address - Country:US
Practice Address - Phone:412-661-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010615367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty