Provider Demographics
NPI:1134318454
Name:WOLF, TERRI JANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:JANE
Last Name:WOLF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 MAXSON ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3417
Mailing Address - Country:US
Mailing Address - Phone:760-966-1675
Mailing Address - Fax:760-231-9331
Practice Address - Street 1:1916 MAXSON ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3417
Practice Address - Country:US
Practice Address - Phone:760-966-1675
Practice Address - Fax:760-231-9331
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595094163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health