Provider Demographics
NPI:1972831493
Name:WOLFE, GLENDA SUE (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:SUE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-0336
Mailing Address - Country:US
Mailing Address - Phone:757-647-5002
Mailing Address - Fax:910-907-1079
Practice Address - Street 1:WAMC STOP A
Practice Address - Street 2:BUILDING 2817 REILLY RD. MCXC COD CS CREDENTIALS
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-8922
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001134686163W00000X
VA0024168543363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse