Provider Demographics
NPI:1275954679
Name:WOLFE, WENDY L
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KIENLE DR
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-4120
Mailing Address - Country:US
Mailing Address - Phone:937-339-5355
Mailing Address - Fax:937-773-3980
Practice Address - Street 1:200 KIENLE DR
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4120
Practice Address - Country:US
Practice Address - Phone:937-339-5355
Practice Address - Fax:937-773-3980
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103598Medicaid