Healthcare Provider Details

I. General information

NPI: 1790177665
Provider Name (Legal Business Name): ASHLEY WOLFRAM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 27TH ST BRAUNLIN BUILDING SUITE 306
PORTSMOUTH OH
45662-2654
US

IV. Provider business mailing address

2400 CORPORATE EXCHANGE DR STE 102
COLUMBUS OH
43231-7651
US

V. Phone/Fax

Practice location:
  • Phone: 740-353-8661
  • Fax: 740-354-3254
Mailing address:
  • Phone: 740-353-8661
  • Fax: 740-354-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004296
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.004296
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: