Healthcare Provider Details

I. General information

NPI: 1720445992
Provider Name (Legal Business Name): MONICA LYNN WILTJER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 2ND ST SW
ROANOKE VA
24016-4710
US

IV. Provider business mailing address

1127 2ND ST SW
ROANOKE VA
24016-4710
US

V. Phone/Fax

Practice location:
  • Phone: 540-400-7495
  • Fax: 877-803-9136
Mailing address:
  • Phone: 540-400-7495
  • Fax: 877-803-9136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-005191
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: