Provider Demographics
NPI:1801824511
Name:WOLF, HEATHER L (PA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:WOLF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SEVEN FARMS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8353
Mailing Address - Country:US
Mailing Address - Phone:843-971-4460
Mailing Address - Fax:
Practice Address - Street 1:225 SEVEN FARMS DR STE 105
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-8353
Practice Address - Country:US
Practice Address - Phone:843-971-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1820363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical