MEDICARE: KATHLEEN WOLFF

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	363LN0005X	Critical Care Neonatal Nurse Practitioner	SP021249	PA

General Provider Information

NPI Number	:	1619514940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN WOLFF

Provider Business Mailing Address
First Line	:	117 S 11TH ST FL 8
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4949
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 S 11TH ST FL 8
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4949
Country	:	US
Telephone Number	:	215-955-8346
Fax Number	:

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

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	07/08/2023

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