Provider Demographics
NPI:1538837661
Name:WOLFE, SUSAN LANNETTE (APRN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LANNETTE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LANNETTE
Other - Last Name:HARROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 SYLVAN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-1802
Mailing Address - Country:US
Mailing Address - Phone:870-820-8001
Mailing Address - Fax:
Practice Address - Street 1:11 SYLVAN HILLS DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671
Practice Address - Country:US
Practice Address - Phone:870-820-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR217290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily