Provider Demographics
NPI:1508682048
Name:WACIK, HUNTER
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:
Last Name:WACIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 E WALKER RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-9348
Mailing Address - Country:US
Mailing Address - Phone:619-582-8965
Mailing Address - Fax:
Practice Address - Street 1:3045 E WALKER RD
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014-9348
Practice Address - Country:US
Practice Address - Phone:619-582-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant