Provider Demographics
NPI:1356771554
Name:WIESENFELD, DANA LEIGH (PA-C)
Entity type:Individual
Prefix:MISS
First Name:DANA
Middle Name:LEIGH
Last Name:WIESENFELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 N DORCAS ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1737
Mailing Address - Country:US
Mailing Address - Phone:717-953-9571
Mailing Address - Fax:717-953-9576
Practice Address - Street 1:6 N DORCAS ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1737
Practice Address - Country:US
Practice Address - Phone:717-953-9571
Practice Address - Fax:717-953-9576
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107626363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3EOZFOtherBCBS
FLP1046279OtherFREEDOM
FL5009736.OtherAVMED
FLP979555OtherOPTIMUM
FL5181955OtherAETNA
FL8KL5ROtherBCBS
FLP01744113OtherRR MEDICARE
FL010979900Medicaid
FLIC933YMedicare PIN