Healthcare Provider Details

I. General information

NPI: 1942236757
Provider Name (Legal Business Name): SUMMER WOLFE DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date: 03/22/2012
Reactivation Date: 03/11/2020

III. Provider practice location address

951 E SAWMILL RD
FLAGSTAFF AZ
86001-5827
US

IV. Provider business mailing address

951 E SAWMILL RD
FLAGSTAFF AZ
86001-5827
US

V. Phone/Fax

Practice location:
  • Phone: 928-774-4523
  • Fax: 928-226-5228
Mailing address:
  • Phone: 928-774-4523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number236722
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC-11825
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: