Provider Demographics
NPI:1730316399
Name:WOLFE, ELIZABETH E
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
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 1:7100 COMMERCE WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BRETNWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2851
Mailing Address - Country:US
Mailing Address - Phone:888-304-1116
Mailing Address - Fax:615-465-2984
Practice Address - Street 1:285 W 12TH ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1653
Practice Address - Country:US
Practice Address - Phone:765-472-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001267A133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education