Provider Demographics
NPI:1083645634
Name:FEHRENBACH WOLFSON, BETHANNE (CRNP)
Entity Type:Individual
Prefix:
First Name:BETHANNE
Middle Name:
Last Name:FEHRENBACH WOLFSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BRIGHTON AVE
Mailing Address - Street 2:MOB 2ND FL
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-365-3100
Mailing Address - Fax:609-926-8096
Practice Address - Street 1:155 BRIGHTON AVE
Practice Address - Street 2:MOB 2ND FL
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:609-365-3100
Practice Address - Fax:609-926-8096
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06289300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P51582Medicare UPIN
NJ550425Medicare ID - Type Unspecified