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General NPI Number Information
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NPI Number | 1346372729
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Entity Type | Individual
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Provider Name | KELLEY MARIE DASOVICH WOLFF PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 5801 ARMY PENTAGON
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City | WASHINGTON
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State | DC
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Zip | 20310-5001
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Country | US
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Telephone | 703-692-8928
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Fax |
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Provider Business Mailing Address
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Address Line | 9300 DEWITT LOOP
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City | FORT BELVOIR
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State | VA
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Zip | 22060-5285
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Country | US
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Telephone | 703-692-8928
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110003223
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | AMD-290
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License Number State | HI
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