Provider Demographics
NPI:1407485089
Name:WOLF, MOLLY K
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:K
Last Name:WOLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 HERCULES DR
Mailing Address - Street 2:STE 110
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8049
Mailing Address - Country:US
Mailing Address - Phone:802-210-5953
Mailing Address - Fax:802-660-9438
Practice Address - Street 1:280 MAIN ST STE 131
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2921
Practice Address - Country:US
Practice Address - Phone:602-577-5353
Practice Address - Fax:603-577-5354
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH065749-23363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health