Provider Demographics
NPI:1023660065
Name:WOLFE, ROBERT (FNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18761 N REEMS RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8646
Mailing Address - Country:US
Mailing Address - Phone:623-583-9180
Mailing Address - Fax:
Practice Address - Street 1:18761 N REEMS RD STE 400
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8646
Practice Address - Country:US
Practice Address - Phone:623-583-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ229046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily