1104041268 NPI number — KAREN ANNE WOLF PHD, APRN-BC,DRNAP

Table of content: KAREN ANNE WOLF PHD, APRN-BC,DRNAP (NPI 1104041268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104041268 NPI number — KAREN ANNE WOLF PHD, APRN-BC,DRNAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLF
Provider First Name:
KAREN
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD, APRN-BC,DRNAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104041268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 DOCK HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLEBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17842-8910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-837-2123
Provider Business Mailing Address Fax Number:
570-837-2185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12560 STATE ROUTE 405
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATSONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17777-8525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-538-2501
Provider Business Practice Location Address Fax Number:
570-538-3227
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  SP014294 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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