MEDICARE: MS. BRIDGET COLLEEN WOLFE CRNA

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	367500000X	Certified Registered Nurse Anesthetist	0024170029	VA

General Provider Information

NPI Number	:	1659371342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRIDGET COLLEEN WOLFE CRNA

Provider Business Mailing Address
First Line	:	PO BOX 37090
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-3090
Country	:	US
Telephone Number	:	703-295-9360
Fax Number	:	703-295-9369

Provider Business Practice Location Address
First Line	:	3620 JOSEPH SIEWICK DR
Second Line	:	ANESTHESIA DEPARTMENT
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1756
Country	:	US
Telephone Number	:	703-922-9501
Fax Number	:	703-295-9369

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	05/30/2012

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