Healthcare Provider Details

I. General information

NPI: 1720010358
Provider Name (Legal Business Name): CARY SUE WOLFE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARY SUE ARAI

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 J D ANDERSON DR
MORGANTOWN WV
26505-3494
US

IV. Provider business mailing address

1325 LOCUST AVE FAIRMONT GENERAL HOSPITAL
FAIRMONT WV
26554-1435
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-9400
  • Fax:
Mailing address:
  • Phone: 304-367-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberTEMP002833
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number68608
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: