Provider Demographics
NPI:1295258473
Name:WOLFE, CHARLES BRIAN (MSN, FNP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:BRIAN
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 STATE ROUTE 903
Mailing Address - Street 2:
Mailing Address - City:ALBRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18210-3756
Mailing Address - Country:US
Mailing Address - Phone:570-645-1945
Mailing Address - Fax:570-645-1946
Practice Address - Street 1:2599 ROUTE 903
Practice Address - Street 2:
Practice Address - City:ALBRIGHTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18210
Practice Address - Country:US
Practice Address - Phone:570-645-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00758000363LF0000X
PASP017589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily