Provider Demographics
NPI:1740956010
Name:TEWELL, MOLLY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:TEWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:ISKULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2060 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-1926
Mailing Address - Country:US
Mailing Address - Phone:814-877-7711
Mailing Address - Fax:814-877-7715
Practice Address - Street 1:4247 W RIDGE RD STE 105
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1746
Practice Address - Country:US
Practice Address - Phone:814-833-3002
Practice Address - Fax:814-835-2587
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005777363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant