Provider Demographics
NPI:1891149878
Name:WOLFE, KRISTEN
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:BAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:455 N 400 W
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-1230
Mailing Address - Country:US
Mailing Address - Phone:801-533-5423
Mailing Address - Fax:
Practice Address - Street 1:455 N 400 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-1230
Practice Address - Country:US
Practice Address - Phone:801-533-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker