MEDICARE: MS. PEGGY LOUISE WOLFF APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364S00000X	Clinical Nurse Specialist	109402	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25600	OTHER	MA	HEATH NEW ENG
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	25600	OTHER	MA	VALUE OPTIONS

General Provider Information

NPI Number	:	1467531426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PEGGY LOUISE WOLFF APRN

Provider Business Mailing Address
First Line	:	126 CAVE HILL ROAD
Second Line	:
City	:	LEVERETT
State	:	MA
Zip	:	01054-9728
Country	:	US
Telephone Number	:	413-367-9638
Fax Number	:	413-253-2150

Provider Business Practice Location Address
First Line	:	126 CAVE HILL ROAD
Second Line	:
City	:	LEVERETT
State	:	MA
Zip	:	01054-9728
Country	:	US
Telephone Number	:	413-367-9638
Fax Number	:	413-253-2150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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