Provider Demographics
NPI:1447512033
Name:WOLLMAN, MARY CATHERINE (NP, CRNP)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CATHERINE
Last Name:WOLLMAN
Suffix:
Gender:F
Credentials:NP, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LYDIA LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-8482
Mailing Address - Country:US
Mailing Address - Phone:215-272-3310
Mailing Address - Fax:
Practice Address - Street 1:121 LYDIA LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-8482
Practice Address - Country:US
Practice Address - Phone:215-272-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP001152H363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology