Provider Demographics
NPI:1205408481
Name:RIVER WOLF GYNECOLOGY & FAMILY HEALTH, PLLC
Entity Type:Organization
Organization Name:RIVER WOLF GYNECOLOGY & FAMILY HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KALLI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, FNP-C
Authorized Official - Phone:405-203-5382
Mailing Address - Street 1:2104 BANBURY LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-3401
Mailing Address - Country:US
Mailing Address - Phone:405-203-5382
Mailing Address - Fax:
Practice Address - Street 1:2104 BANBURY LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-3401
Practice Address - Country:US
Practice Address - Phone:405-203-5382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty