Provider Demographics
NPI:1659745412
Name:WOLFE, JOEL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EAST PARKER MCKENZINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005
Mailing Address - Country:US
Mailing Address - Phone:405-247-7900
Mailing Address - Fax:
Practice Address - Street 1:201 EAST PARKER MCKENZINE DRIVE
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005
Practice Address - Country:US
Practice Address - Phone:405-247-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36501164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse