Provider Demographics
NPI:1265137194
Name:WOENKHAUS, OLIVIA KAY (PA)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:KAY
Last Name:WOENKHAUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:KAY
Other - Last Name:GERARDOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-458-3045
Mailing Address - Fax:260-458-3046
Practice Address - Street 1:2516 E DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1608
Practice Address - Country:US
Practice Address - Phone:260-458-3045
Practice Address - Fax:260-458-3046
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant