Provider Demographics
NPI:1255850137
Name:WOLFE, LORI LEAGUE (NP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LEAGUE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 JOHNSTON RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-9506
Mailing Address - Country:US
Mailing Address - Phone:1925-918-2190
Mailing Address - Fax:
Practice Address - Street 1:6000 JOHNSTON RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-9506
Practice Address - Country:US
Practice Address - Phone:192-591-8219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007313363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner