Healthcare Provider Details

I. General information

NPI: 1295258473
Provider Name (Legal Business Name): CHARLES BRIAN WOLFE MSN, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N BEVERLY DR # CA90210
BEVERLY HILLS CA
90210-4600
US

IV. Provider business mailing address

65 W 36TH ST FL 11
NEW YORK NY
10018-7936
US

V. Phone/Fax

Practice location:
  • Phone: 888-803-3370
  • Fax: 888-803-3331
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017589
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95036154
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00758000
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN10024395
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00758000
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number357680
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR273122
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: