Provider Demographics
NPI:1770669103
Name:WOLFE, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DELAFIELD RD
Mailing Address - Street 2:SUITE 3060
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-3205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 DELAFIELD RD
Practice Address - Street 2:SUITE 3060
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-3205
Practice Address - Country:US
Practice Address - Phone:412-781-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003355L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1047452OtherNCCPA CERTIFIED
PA1770669103OtherPALMETTO
PAMA003355LOtherPA STATE LICENSE
PAMA003355LOtherPA STATE LICENSE