Provider Demographics
NPI:1336195668
Name:WOLFF, JESSICA (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WOLFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 LOCUST ST
Mailing Address - Street 2:#1
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2018
Mailing Address - Country:US
Mailing Address - Phone:413-584-2303
Mailing Address - Fax:413-586-3212
Practice Address - Street 1:61 LOCUST ST
Practice Address - Street 2:#1
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2018
Practice Address - Country:US
Practice Address - Phone:413-584-2303
Practice Address - Fax:413-586-3212
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239213363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP3128OtherBCBS MA
MANP3128OtherBCBS MA
P27599Medicare UPIN