Healthcare Provider Details

I. General information

NPI: 1871744227
Provider Name (Legal Business Name): THERESA WOLFE NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 NORWOOD DR
WAMPUM PA
16157-2505
US

IV. Provider business mailing address

1756 PORTER ST
CONWAY PA
15027-1343
US

V. Phone/Fax

Practice location:
  • Phone: 724-891-1274
  • Fax:
Mailing address:
  • Phone: 724-869-4215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN253282L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: