Provider Demographics
NPI:1487652541
Name:WOLFORD, TERESA D (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:D
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 OLDTOWN ROAD-REAR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:301-777-9393
Mailing Address - Fax:301-777-9066
Practice Address - Street 1:517 OLDTOWN ROAD-REAR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-777-9393
Practice Address - Fax:301-777-9066
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR079913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P19822Medicare UPIN