Provider Demographics
NPI:1063408219
Name:WOLTZ, MICHELLE EILEEN (CRNP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:EILEEN
Last Name:WOLTZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-3412
Mailing Address - Country:US
Mailing Address - Phone:610-209-8027
Mailing Address - Fax:215-625-2372
Practice Address - Street 1:229 ARCH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-1915
Practice Address - Country:US
Practice Address - Phone:215-625-8030
Practice Address - Fax:215-625-2372
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP000746G363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health