Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 341806 | NY |
NPI | 1003338096 |
---|---|
Provider Name | Megan Marie Wolfe |
First Address | Syracuse, NY 13203-1807 |
Second Address | Liverpool, NY 13088-3808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2017 |
Last Update Date | 29/09/2017 |