Provider Demographics
NPI:1679184378
Name:WOLFE, WILLIAM HENRY
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
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 1:5076 WELTON ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-8176
Mailing Address - Country:US
Mailing Address - Phone:681-231-1264
Mailing Address - Fax:
Practice Address - Street 1:121 RIO GRANDE RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-5496
Practice Address - Country:US
Practice Address - Phone:304-257-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker