Provider Demographics
NPI:1326675026
Name:WOLF, LYNN SOFIA (CNM, PMHNP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:SOFIA
Last Name:WOLF
Suffix:
Gender:F
Credentials:CNM, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5223 CROOKED LN
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-2520
Mailing Address - Country:US
Mailing Address - Phone:804-938-1752
Mailing Address - Fax:
Practice Address - Street 1:4108 E PARHAM RD STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2754
Practice Address - Country:US
Practice Address - Phone:615-478-6748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CNM06288176B00000X, 367A00000X
VA0024179066363LX0001X, 363LP0808X
FLAPRN11022345367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No176B00000XOther Service ProvidersMidwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife