Provider Demographics
NPI:1265213862
Name:WOLFE, KATIE LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LOUISE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1115
Mailing Address - Country:US
Mailing Address - Phone:716-604-2879
Mailing Address - Fax:
Practice Address - Street 1:1140 EDWARDS VILLAGE BLVD UNIT B-105
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-5525
Practice Address - Country:US
Practice Address - Phone:970-569-3240
Practice Address - Fax:970-569-3260
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant