Provider Demographics
NPI:1770170045
Name:WOLFENSON, MARY ANN (RN, DNP)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:WOLFENSON
Suffix:
Gender:F
Credentials:RN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1068
Mailing Address - Country:US
Mailing Address - Phone:708-925-2502
Mailing Address - Fax:
Practice Address - Street 1:4650 N CENTRAL AVE UNIT 174
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1072
Practice Address - Country:US
Practice Address - Phone:708-925-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041197834163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health