Provider Demographics
NPI:1457456717
Name:WOLBERT, ROBERT (CRNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WOLBERT
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301
Mailing Address - Country:US
Mailing Address - Phone:814-676-8571
Mailing Address - Fax:814-676-9155
Practice Address - Street 1:1 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301
Practice Address - Country:US
Practice Address - Phone:814-676-8571
Practice Address - Fax:814-676-9155
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005640B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily