Provider Demographics
NPI:1538654132
Name:WOLFE, TAYLOR BROOKE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BROOKE
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 1:1669 BALLARD DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-2831
Mailing Address - Country:US
Mailing Address - Phone:903-517-0440
Mailing Address - Fax:
Practice Address - Street 1:1669 BALLARD DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-2831
Practice Address - Country:US
Practice Address - Phone:903-517-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343565164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse