Provider Demographics
NPI:1922176023
Name:WOLFE, PAULA B (RD)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:B
Last Name:WOLFE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37623 244TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-8861
Mailing Address - Country:US
Mailing Address - Phone:306-802-4860
Mailing Address - Fax:
Practice Address - Street 1:13111 SE 274TH ST
Practice Address - Street 2:SUITE # 208
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-8929
Practice Address - Country:US
Practice Address - Phone:206-296-4926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DI00000140133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8270266Medicaid