Provider Demographics
NPI:1467069609
Name:WOLFELT, LORRIE ANN
Entity Type:Individual
Prefix:
First Name:LORRIE
Middle Name:ANN
Last Name:WOLFELT
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 1:2610 COURTLY RD
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-1324
Mailing Address - Country:US
Mailing Address - Phone:419-435-0786
Mailing Address - Fax:
Practice Address - Street 1:2610 COURTLY RD
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1324
Practice Address - Country:US
Practice Address - Phone:419-435-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251X00000X
OHRK393140347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No347C00000XTransportation ServicesPrivate Vehicle