Provider Demographics
NPI:1902139728
Name:HANZELY, DULCIE ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DULCIE
Middle Name:ANN
Last Name:HANZELY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:DULCIE
Other - Middle Name:ANN
Other - Last Name:SWOPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-4200
Mailing Address - Fax:814-375-4232
Practice Address - Street 1:621 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1413
Practice Address - Country:US
Practice Address - Phone:814-299-7520
Practice Address - Fax:814-375-7798
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054107363A00000X
PATMA052166363A00000X
PAOA003947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103196710Medicaid
PA2137822OtherHIGHMARK MEDICARE MANAGED CARE