Provider Demographics
NPI:1225238082
Name:WOLFGANG, HEIDI ANNE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:HEIDI
Middle Name:ANNE
Last Name:WOLFGANG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:01525-0219
Mailing Address - Country:US
Mailing Address - Phone:978-333-1760
Mailing Address - Fax:
Practice Address - Street 1:161 PROVIDENCE ROAD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:MA
Practice Address - Zip Code:01525
Practice Address - Country:US
Practice Address - Phone:978-333-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59094164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse