Healthcare Provider Details

I. General information

NPI: 1972175289
Provider Name (Legal Business Name): ASHLEY MARIE DUNKELBERGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHELY FANNICK

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 GREENVIEW DR
STATE COLLEGE PA
16803-2106
US

IV. Provider business mailing address

1800 E PARK AVE
STATE COLLEGE PA
16803-6797
US

V. Phone/Fax

Practice location:
  • Phone: 814-237-4321
  • Fax: 814-235-0484
Mailing address:
  • Phone: 814-231-7000
  • Fax: 814-231-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062920
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: