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General NPI Number Information
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NPI Number | 1558096826
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Entity Type | Individual
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Provider Name | STACEY NICOLE WOLF CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 301 HOSPITAL DR
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5803
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Country | US
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Telephone | 410-787-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 851 TRAFALGAR CT STE 200E
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City | MAITLAND
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State | FL
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Zip | 32751-7420
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Country | US
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Telephone | 407-667-0444
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R207853
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R207853
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License Number State | MD
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