Provider Demographics
NPI:1679088454
Name:WOLKE, ERIC PAUL
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:PAUL
Last Name:WOLKE
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 1:134 11TH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OR
Mailing Address - Zip Code:97352-9353
Mailing Address - Country:US
Mailing Address - Phone:503-409-3801
Mailing Address - Fax:
Practice Address - Street 1:2225 PACIFIC BLVD SE STE 207
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-7904
Practice Address - Country:US
Practice Address - Phone:971-720-6299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-03
Last Update Date:2017-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2345376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker