Healthcare Provider Details

I. General information

NPI: 1902139728
Provider Name (Legal Business Name): DULCIE ANN HANZELY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DULCIE ANN SWOPE PA-C

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S MAIN ST
DU BOIS PA
15801-1413
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-299-7520
  • Fax: 814-375-7798
Mailing address:
  • Phone: 814-375-4200
  • Fax: 814-375-4232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA054107
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTMA052166
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003947
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: