Provider Demographics
NPI:1174509632
Name:WOLF, SUZANNE (FNP RN MSN)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:FNP RN MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:BMAC CREDENTIALING
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-5674
Mailing Address - Fax:843-522-5678
Practice Address - Street 1:BEAUFORT MEMORIAL OBSTETRICS & GYNECOLOGY SPECIALISTS
Practice Address - Street 2:989 RIBAUT RD, STE 210
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5472
Practice Address - Country:US
Practice Address - Phone:843-522-7820
Practice Address - Fax:844-296-2295
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC64779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3038Medicaid