Provider Demographics
NPI:1720010358
Name:WOLFE, CARY SUE (CRNA)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:SUE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CARY
Other - Middle Name:SUE
Other - Last Name:ARAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1325 LOCUST AVE
Mailing Address - Street 2:FAIRMONT GENERAL HOSPITAL
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1435
Mailing Address - Country:US
Mailing Address - Phone:304-367-7100
Mailing Address - Fax:
Practice Address - Street 1:1200 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3494
Practice Address - Country:US
Practice Address - Phone:304-346-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVTEMP002833367500000X
WV68608367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0207026000Medicaid
WV3810006746Medicaid
WV002010982OtherMSBCBS
WV3810008140Medicaid
WV001907661OtherMSBCBS
OH2808484Medicaid
WV001706470OtherMSBCBS
WV3810008140Medicaid
WV3810006746Medicaid
WV8238502Medicare PIN