Basic Information
| Provider Information | |||||||||
| NPI: | 1447922752 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLFE | ||||||||
| FirstName: | FAWN | ||||||||
| MiddleName: | N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 OSTRUM ST STE 501 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845037000 | ||||||||
| FaxNumber: | 4845037001 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 OSTRUM ST STE 501 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845037000 | ||||||||
| FaxNumber: | 4845037001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2021 | ||||||||
| LastUpdateDate: | 10/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP024483 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.