Provider Demographics
NPI:1699369884
Name:WOLFE, CAITLYN NICOLE
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:NICOLE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-2525
Mailing Address - Country:US
Mailing Address - Phone:304-813-0316
Mailing Address - Fax:304-788-6363
Practice Address - Street 1:323 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2525
Practice Address - Country:US
Practice Address - Phone:304-813-0316
Practice Address - Fax:304-788-6363
Is Sole Proprietor?:No
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV835513747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant