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General NPI Number Information
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NPI Number | 1972831493
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Entity Type | Individual
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Provider Name | GLENDA SUE WOLFE PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/20/2009
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Last Update Date | 11/20/2009
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Provider Practice Location Address
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Address Line | WAMC STOP A BUILDING 2817 REILLY RD. MCXC COD CS CREDENTIALS
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City | FORT BRAGG
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State | NC
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Zip | 28310-0001
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Country | US
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Telephone | 910-907-8922
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Fax | 910-907-6069
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Provider Business Mailing Address
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Address Line | PO BOX 336
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City | RAEFORD
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State | NC
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Zip | 28376-0336
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Country | US
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Telephone | 757-647-5002
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Fax | 910-907-1079
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024168543
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001134686
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License Number State | VA
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