Provider Demographics
NPI:1609072248
Name:WOLFE, SUSAN R (APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:WOLFE
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:1705 CHRISTY DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-5195
Mailing Address - Country:US
Mailing Address - Phone:573-635-0621
Mailing Address - Fax:573-635-3534
Practice Address - Street 1:1705 CHRISTY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-5195
Practice Address - Country:US
Practice Address - Phone:573-635-0621
Practice Address - Fax:573-635-3534
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2023-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO149413363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health