Provider Demographics
NPI:1740413079
Name:WOLLF, NICHOLE A (CMA)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:A
Last Name:WOLLF
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 TIGER DR
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-6812
Mailing Address - Country:US
Mailing Address - Phone:615-597-7599
Mailing Address - Fax:
Practice Address - Street 1:254 TIGER DR
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-6812
Practice Address - Country:US
Practice Address - Phone:615-597-7599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN676921376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide