Provider Demographics
NPI:1093531170
Name:WOLLENBERG, KATHERINE ANN (FNP-C)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ANN
Last Name:WOLLENBERG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12709 CHERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1641
Mailing Address - Country:US
Mailing Address - Phone:540-746-0911
Mailing Address - Fax:
Practice Address - Street 1:12709 CHERRYWOOD LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1641
Practice Address - Country:US
Practice Address - Phone:540-746-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR269798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily