Provider Demographics
NPI:1144774472
Name:WOLF, ANGELA JAYNE (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JAYNE
Last Name:WOLF
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 2ND AVE
Mailing Address - Street 2:APT. A2
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2700
Mailing Address - Country:US
Mailing Address - Phone:313-320-3116
Mailing Address - Fax:
Practice Address - Street 1:7409 2ND AVE
Practice Address - Street 2:APT. A2
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2700
Practice Address - Country:US
Practice Address - Phone:313-320-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704266624363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care