Provider Demographics
NPI:1831430800
Name:WOLFSON, ANNA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2530
Mailing Address - Country:US
Mailing Address - Phone:646-369-3746
Mailing Address - Fax:
Practice Address - Street 1:1000 BERGEN TOWN CTR
Practice Address - Street 2:CVS CAREMARK
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5016
Practice Address - Country:US
Practice Address - Phone:646-369-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00425000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily