Provider Demographics
NPI:1821780677
Name:WOLF, LAURA (MS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3544
Mailing Address - Country:US
Mailing Address - Phone:646-704-1337
Mailing Address - Fax:
Practice Address - Street 1:100 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3544
Practice Address - Country:US
Practice Address - Phone:646-704-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist