Provider Demographics
NPI:1659371342
Name:WOLFE, BRIDGET COLLEEN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:COLLEEN
Last Name:WOLFE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 37090
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3090
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-295-9369
Practice Address - Street 1:3620 JOSEPH SIEWICK DR
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1756
Practice Address - Country:US
Practice Address - Phone:703-922-9501
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170029367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered