Healthcare Provider Details

I. General information

NPI: 1811325608
Provider Name (Legal Business Name): ALICIA M WURM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 JOHNSONBURG RD SUITE 110
SAINT MARYS PA
15857-3488
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-834-2850
  • Fax: 814-781-1580
Mailing address:
  • Phone: 814-375-6560
  • Fax: 814-372-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA056509
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: