MEDICARE: MS. MICHELLE EILEEN WOLTZ CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	TP000746G	PA

General Provider Information

NPI Number	:	1063408219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE EILEEN WOLTZ CRNP

Provider Business Mailing Address
First Line	:	649 MANOR DR
Second Line	:
City	:	HORSHAM
State	:	PA
Zip	:	19044-3412
Country	:	US
Telephone Number	:	610-209-8027
Fax Number	:	215-625-2372

Provider Business Practice Location Address
First Line	:	229 ARCH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-1915
Country	:	US
Telephone Number	:	215-625-8030
Fax Number	:	215-625-2372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	01/07/2009

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