Provider Demographics
NPI:1720445992
Name:WILTJER, MONICA LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:LYNN
Last Name:WILTJER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5712 BIGHORN DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6102
Mailing Address - Country:US
Mailing Address - Phone:919-272-3025
Mailing Address - Fax:
Practice Address - Street 1:1625 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-6390
Practice Address - Country:US
Practice Address - Phone:540-483-0373
Practice Address - Fax:877-803-9136
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110-005191363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant