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General NPI Number Information
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NPI Number | 1013007723
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Entity Type | Individual
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Provider Name | WANEDA KAY WOLFE M.N., C.N.S., A.N.P.
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 100 DOCTORS DR STE C
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City | PANAMA CITY
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State | FL
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Zip | 32405-7609
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Country | US
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Telephone | 850-814-8400
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Fax | 850-215-8405
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Provider Business Mailing Address
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Address Line | PO BOX 913
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City | PANAMA CITY
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State | FL
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Zip | 32402-0913
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Country | US
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Telephone | 850-814-8400
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Fax | 850-215-8405
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP3417872
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 364SP0812X
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Taxonomy Name | Community Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | ARNP3417872
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License Number State | FL
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