MEDICARE: MRS. SUSAN ULMER DEWOLF CRNFA, NP-C

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	363L00000X	Nurse Practitioner	RN097274	GA

General Provider Information

NPI Number	:	1518966175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN ULMER DEWOLF CRNFA, NP-C

Provider Business Mailing Address
First Line	:	4542 HIGH ROCK TER
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-1606
Country	:	US
Telephone Number	:	678-488-7299
Fax Number	:	770-578-8405

Provider Business Practice Location Address
First Line	:	4542 HIGH ROCK TER
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-1606
Country	:	US
Telephone Number	:	678-488-7299
Fax Number	:	770-578-8405

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

Provider Enumeration Date	:	07/17/2005
Last Update Date	:	07/08/2007

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