Provider Demographics
NPI:1568688315
Name:WOLF, THERESA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:WOLF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:NEWCOMERSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43832-1062
Mailing Address - Country:US
Mailing Address - Phone:740-498-4701
Mailing Address - Fax:
Practice Address - Street 1:502 CROSS ST
Practice Address - Street 2:
Practice Address - City:NEWCOMERSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43832-1062
Practice Address - Country:US
Practice Address - Phone:740-498-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 085869164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse