Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 35.089428 | OH |
N | 111NI0900X | Internist | 35.089428 | OH |
N | 208000000X | Pediatrician | 35.089428 | OH |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD442260 | PA |
N | 2080P0203X | Pediatric Critical Care Doctor | MT196390 | PA |
NPI | 1154533800 |
---|---|
Provider Name | Heather Ann Wolfe |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 25/10/2019 |