Provider Demographics
NPI:1104041268
Name:WOLF, KAREN ANNE (PHD, APRN-BC,DRNAP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANNE
Last Name:WOLF
Suffix:
Gender:F
Credentials:PHD, APRN-BC,DRNAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:12560 STATE ROUTE 405
Practice Address - Street 2:
Practice Address - City:WATSONTOWN
Practice Address - State:PA
Practice Address - Zip Code:17777-8525
Practice Address - Country:US
Practice Address - Phone:570-538-2501
Practice Address - Fax:570-538-3227
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014294363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S69139Medicare UPIN
MANP1489OtherBCBS MA
MAUX8686Medicare PIN