Provider Demographics
NPI:1316975048
Name:WAMBOLDT, CAROL L (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:L
Last Name:WAMBOLDT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 GREENSPRING AVE
Mailing Address - Street 2:300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4354
Mailing Address - Country:US
Mailing Address - Phone:410-601-1900
Mailing Address - Fax:410-601-1901
Practice Address - Street 1:5051 GREENSPRING AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4354
Practice Address - Country:US
Practice Address - Phone:410-601-1900
Practice Address - Fax:410-601-1901
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR156968174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist