Provider Demographics
NPI:1770952756
Name:PASTULA, MICHELLE E (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:PASTULA
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 1:1953 LEITHSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-2510
Mailing Address - Country:US
Mailing Address - Phone:610-390-5248
Mailing Address - Fax:
Practice Address - Street 1:15 MAIN ST
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1742
Practice Address - Country:US
Practice Address - Phone:610-456-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-19
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057809363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant