Provider Demographics
NPI:1972651644
Name:WOLF, JOAN COLLETTE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:COLLETTE
Last Name:WOLF
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 TRAILRIDE WAY CITRUS HEIGHTS CA 95621
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621
Mailing Address - Country:US
Mailing Address - Phone:916-973-6109
Mailing Address - Fax:
Practice Address - Street 1:20025 MORSE AVE SUITE 2E
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-973-6109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14765363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical