Provider Demographics
NPI:1184239014
Name:WOLFE, LILLIAN ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:ANN
Last Name:WOLFE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:ANN
Other - Last Name:BLASZCYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 CHIP DR
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-9541
Mailing Address - Country:US
Mailing Address - Phone:631-495-4397
Mailing Address - Fax:
Practice Address - Street 1:57190 MAIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-4750
Practice Address - Country:US
Practice Address - Phone:631-626-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346129363LF0000X
NYF346129-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily