Provider Demographics
NPI:1639676992
Name:WOLF, CHRISTINA LORENE (AGACNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LORENE
Last Name:WOLF
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 KING ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-6215
Mailing Address - Country:US
Mailing Address - Phone:360-594-4002
Mailing Address - Fax:360-594-4006
Practice Address - Street 1:1344 KING ST STE 104
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6215
Practice Address - Country:US
Practice Address - Phone:360-594-4002
Practice Address - Fax:360-594-4006
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60812900163W00000X
WA60829939363LA2100X
CANP95007820363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse