Healthcare Provider Details

I. General information

NPI: 1407612211
Provider Name (Legal Business Name): HALLIE MUFFLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 SCHOENERSVILLE RD STE 202
BETHLEHEM PA
18017-7316
US

IV. Provider business mailing address

4049 BUTTERNUT DR
WALNUTPORT PA
18088-9337
US

V. Phone/Fax

Practice location:
  • Phone: 484-884-1007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA065330
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: