Provider Demographics
NPI:1801276522
Name:WILEY, EMILY (PA-C)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2005 TECHNOLOGY PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9413
Mailing Address - Country:US
Mailing Address - Phone:717-791-2520
Mailing Address - Fax:717-703-0061
Practice Address - Street 1:2005 TECHNOLOGY PKWY STE 400
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9413
Practice Address - Country:US
Practice Address - Phone:717-791-2520
Practice Address - Fax:717-703-0061
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057815363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103166470Medicaid