Provider Demographics
NPI:1790345981
Name:WOLFFE, LISA (CNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WOLFFE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JANES ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43128-1045
Mailing Address - Country:US
Mailing Address - Phone:740-505-5321
Mailing Address - Fax:
Practice Address - Street 1:9 JANES ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:43128-1045
Practice Address - Country:US
Practice Address - Phone:740-505-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH024573363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner