Provider Demographics
NPI:1043249600
Name:WOLFF, MARY E (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:WOLFF
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:TREXLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18087-0813
Mailing Address - Country:US
Mailing Address - Phone:610-481-0481
Mailing Address - Fax:610-481-0486
Practice Address - Street 1:29 N 9TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-1102
Practice Address - Country:US
Practice Address - Phone:610-481-0481
Practice Address - Fax:610-481-0481
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP004289G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026733890004Medicaid
PA1026733890002Medicaid