Provider Demographics
NPI:1033501937
Name:WOLFORD, TODD NOEL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:NOEL
Last Name:WOLFORD
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10176 W 400 N STE B
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9009
Mailing Address - Country:US
Mailing Address - Phone:219-809-9839
Mailing Address - Fax:219-809-9841
Practice Address - Street 1:10176 W 400 N STE B
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9009
Practice Address - Country:US
Practice Address - Phone:219-809-9839
Practice Address - Fax:219-809-9841
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005415A363LF0000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1033501937Medicaid