Provider Demographics
NPI:1649394453
Name:WOOLF, WYNONA ANN (RD, MPH)
Entity Type:Individual
Prefix:
First Name:WYNONA
Middle Name:ANN
Last Name:WOOLF
Suffix:
Gender:F
Credentials:RD, MPH
Other - Prefix:
Other - First Name:NONIE
Other - Middle Name:ANN
Other - Last Name:WOOLF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:HOSPITAL CIRCLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417
Mailing Address - Country:US
Mailing Address - Phone:406-338-6124
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417
Practice Address - Country:US
Practice Address - Phone:406-338-6124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT214133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP57209Medicare UPIN