Individual
GWEN GARIBALDI WOLFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
12 BROOKES XING, PONTOTOC, MS 38863-1009
(662) 489-4044
Mailing address
12 BROOKES XING, PONTOTOC, MS 38863-1009
(662) 489-4044
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
902381
MS
363LF0000X
Family Nurse Practitioner
Primary
APN23055
TN
Other
Enumeration date
09/14/2017
Last updated
10/25/2017
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