Healthcare Provider Details

I. General information

NPI: 1598031130
Provider Name (Legal Business Name): ERIN C WOLF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8030 N 19TH AVE
PHOENIX AZ
85021-5101
US

IV. Provider business mailing address

9060 E VIA LINDA STE 250
SCOTTSDALE AZ
85258-5425
US

V. Phone/Fax

Practice location:
  • Phone: 888-698-6727
  • Fax:
Mailing address:
  • Phone: 480-545-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1338
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22149
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA22149
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5091
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: