Provider Demographics
NPI:1619357381
Name:WOLFF, MARLO
Entity Type:Individual
Prefix:MRS
First Name:MARLO
Middle Name:
Last Name:WOLFF
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:PO BOX 2213
Mailing Address - Street 2:713 J L CHESTNUT BLVD
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-2213
Mailing Address - Country:US
Mailing Address - Phone:334-874-7428
Mailing Address - Fax:334-874-7435
Practice Address - Street 1:867 COUNTY ROAD 59
Practice Address - Street 2:
Practice Address - City:PINE APPLE
Practice Address - State:AL
Practice Address - Zip Code:36768-3525
Practice Address - Country:US
Practice Address - Phone:251-746-2197
Practice Address - Fax:251-746-2467
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-087171163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse