Provider Demographics
NPI:1851379028
Name:WOLF, MARY L (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:WOLF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 JEFFERSON HWY
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093-6563
Mailing Address - Country:US
Mailing Address - Phone:540-967-9401
Mailing Address - Fax:540-967-9405
Practice Address - Street 1:115 JEFFERSON HWY
Practice Address - Street 2:SUITE 9
Practice Address - City:LOUISA
Practice Address - State:VA
Practice Address - Zip Code:23093-6563
Practice Address - Country:US
Practice Address - Phone:540-967-9401
Practice Address - Fax:540-967-9405
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024134693363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner