Provider Demographics
NPI:1033718051
Name:WOLFGANG, CHARLENE MARTIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARTIN
Last Name:WOLFGANG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 MEGAN DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-7422
Mailing Address - Country:US
Mailing Address - Phone:904-316-4116
Mailing Address - Fax:
Practice Address - Street 1:806 MEGAN DR
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-7422
Practice Address - Country:US
Practice Address - Phone:904-316-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily