=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134314271
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA J. WOLF CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2007
-----------------------------------------------------
Last Update Date | 09/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6565 N CHARLES ST SUITE 209
-----------------------------------------------------
City | TOWSON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21204-6800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-849-6255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6565 N CHARLES ST SUITE 209
-----------------------------------------------------
City | TOWSON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21204-6800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-849-6255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 125973
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------