Provider Demographics
NPI:1497472443
Name:WOLFE, TYLER ANNE
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:ANNE
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 1:445 SHREWSBURY DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-3671
Mailing Address - Country:US
Mailing Address - Phone:248-705-6541
Mailing Address - Fax:
Practice Address - Street 1:445 SHREWSBURY DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-3671
Practice Address - Country:US
Practice Address - Phone:248-705-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant