Healthcare Provider Details

I. General information

NPI: 1447512033
Provider Name (Legal Business Name): MARY CATHERINE WOLLMAN NP, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 LYDIA LN
WEST CHESTER PA
19382-8482
US

IV. Provider business mailing address

121 LYDIA LN
WEST CHESTER PA
19382-8482
US

V. Phone/Fax

Practice location:
  • Phone: 215-272-3310
  • Fax:
Mailing address:
  • Phone: 215-272-3310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberTP001152H
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: