Individual
JENNIFER LACEY WOLSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
449 N WENDOVER RD STE A, CHARLOTTE, NC 28211-1064
(704) 365-6730
(704) 365-6731
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 365-6730
(704) 365-6731
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0010-01986
NC
363AS0400X
Surgical Physician Assistant
0010-01986
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015PA
—
SC
05
—
1275765968
—
NC
Enumeration date
08/14/2009
Last updated
10/25/2020
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