Provider Demographics
NPI:1659642023
Name:WOLFE, MARINA TERESA (CNP)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:TERESA
Last Name:WOLFE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4966 GLENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-3905
Mailing Address - Country:US
Mailing Address - Phone:513-684-7977
Mailing Address - Fax:513-244-1829
Practice Address - Street 1:4966 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3905
Practice Address - Country:US
Practice Address - Phone:513-684-7977
Practice Address - Fax:513-244-1829
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13007-NP363LF0000X
OH13007363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0142763Medicaid