Provider Demographics
NPI:1801052410
Name:WOLFORD, CONNIE S (RN, MSN, NP)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:RN, MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 QUARRY RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1416
Mailing Address - Country:US
Mailing Address - Phone:650-723-0158
Mailing Address - Fax:650-725-9526
Practice Address - Street 1:211 QUARRY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1416
Practice Address - Country:US
Practice Address - Phone:650-723-0158
Practice Address - Fax:650-725-9526
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA525441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner