Provider Demographics
NPI:1568815538
Name:WOLF LEWIS, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:WOLF LEWIS
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 1:3832 GABRIELLE DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7282
Mailing Address - Country:US
Mailing Address - Phone:614-313-4000
Mailing Address - Fax:
Practice Address - Street 1:3832 GABRIELLE DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-7282
Practice Address - Country:US
Practice Address - Phone:614-313-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.06942174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist