Provider Demographics
NPI:1154474716
Name:WOLVERTON, BRIGITTE KARIN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRIGITTE
Middle Name:KARIN
Last Name:WOLVERTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5620 VISTA DEL MAR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3266
Mailing Address - Country:US
Mailing Address - Phone:714-334-4696
Mailing Address - Fax:
Practice Address - Street 1:3851 S SOTO ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CA
Practice Address - Zip Code:90058-1718
Practice Address - Country:US
Practice Address - Phone:323-585-7162
Practice Address - Fax:323-585-0167
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15094363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant