Provider Demographics
NPI:1326735135
Name:WOLFE, ALEXANDRA GRAYCE
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:GRAYCE
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 1:16997 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5401
Mailing Address - Country:US
Mailing Address - Phone:248-515-8952
Mailing Address - Fax:
Practice Address - Street 1:16997 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5401
Practice Address - Country:US
Practice Address - Phone:248-515-8952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704322713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily