Provider Demographics
NPI:1346591112
Name:WOLFE, REBECCA EVERETT (RDHAP, BS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:EVERETT
Last Name:WOLFE
Suffix:
Gender:F
Credentials:RDHAP, BS
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 2313
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93275-2313
Mailing Address - Country:US
Mailing Address - Phone:559-359-8609
Mailing Address - Fax:559-359-8609
Practice Address - Street 1:2412 LA PALOMA DR
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-7746
Practice Address - Country:US
Practice Address - Phone:559-359-8609
Practice Address - Fax:559-359-8609
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP 439124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist