Provider Demographics
NPI:1407578396
Name:WOLFRAM, CHRISTIN TAYLOR (NP)
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:TAYLOR
Last Name:WOLFRAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1306
Mailing Address - Fax:937-522-7017
Practice Address - Street 1:101 E ALEX BELL RD STE 190
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2752
Practice Address - Country:US
Practice Address - Phone:937-425-4030
Practice Address - Fax:937-425-4039
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1407578396Medicaid