Provider Demographics
NPI:1245588870
Name:WOLFE, JENNIFER LORRAINE (BHRS)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LORRAINE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 36TH ST
Mailing Address - Street 2:101
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4743
Mailing Address - Country:US
Mailing Address - Phone:405-573-9905
Mailing Address - Fax:405-701-0590
Practice Address - Street 1:448 36TH ST
Practice Address - Street 2:101
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4743
Practice Address - Country:US
Practice Address - Phone:405-573-9905
Practice Address - Fax:405-701-0590
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator