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General NPI Number Information
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NPI Number | 1740956010
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Entity Type | Individual
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Provider Name | MOLLY ANN TEWELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 4247 W RIDGE RD STE 105
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City | ERIE
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State | PA
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Zip | 16506-1746
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Country | US
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Telephone | 814-833-3002
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Fax | 814-835-2587
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Provider Business Mailing Address
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Address Line | 2060 N PEARL ST
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City | NORTH EAST
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State | PA
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Zip | 16428-1926
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Country | US
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Telephone | 814-877-7711
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Fax | 814-877-7715
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA005777
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License Number State | PA
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