Provider Demographics
NPI:1780031484
Name:WOLFE, AMY (NP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 E GRAND RIVER AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4958
Mailing Address - Country:US
Mailing Address - Phone:517-333-7113
Mailing Address - Fax:517-333-7125
Practice Address - Street 1:1750 E GRAND RIVER AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4958
Practice Address - Country:US
Practice Address - Phone:517-333-7113
Practice Address - Fax:517-333-7125
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704274427363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner