Provider Demographics
NPI:1629032677
Name:WOLT, LINDA LEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LEE
Last Name:WOLT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 E 8850 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-3706
Mailing Address - Country:US
Mailing Address - Phone:801-255-8271
Mailing Address - Fax:801-273-6363
Practice Address - Street 1:4460 HIGHLAND DR
Practice Address - Street 2:300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3543
Practice Address - Country:US
Practice Address - Phone:801-273-6354
Practice Address - Fax:801-273-6363
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT212236-3102163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management