Provider Demographics
NPI:1689693160
Name:WOLFSON, IRIS S (BSRN,CNM)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:S
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:BSRN,CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 W PHIL ELLENA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2717
Mailing Address - Country:US
Mailing Address - Phone:215-842-1657
Mailing Address - Fax:215-842-2837
Practice Address - Street 1:133 W PHIL ELLENA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2717
Practice Address - Country:US
Practice Address - Phone:215-842-1657
Practice Address - Fax:215-842-2837
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008153L363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health