Provider Demographics
NPI:1447922752
Name:WOLFE, FAWN N
Entity type:Individual
Prefix:
First Name:FAWN
Middle Name:N
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 OSTRUM ST STE 501
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1153
Mailing Address - Country:US
Mailing Address - Phone:484-503-7000
Mailing Address - Fax:484-503-7001
Practice Address - Street 1:701 OSTRUM ST STE 501
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1153
Practice Address - Country:US
Practice Address - Phone:484-503-7000
Practice Address - Fax:484-503-7001
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024483363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner