Provider Demographics
NPI:1376210906
Name:WOLF, ABIGAIL RUTH (LDEM)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:RUTH
Last Name:WOLF
Suffix:
Gender:F
Credentials:LDEM
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDEM
Mailing Address - Street 1:89 CAMERON LOOP
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-600-9938
Mailing Address - Fax:406-219-5991
Practice Address - Street 1:7600 SHEDHORN DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-9462
Practice Address - Country:US
Practice Address - Phone:406-600-9938
Practice Address - Fax:406-219-5991
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2297176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife