Provider Demographics
NPI:1447654405
Name:WOLF, JEFFREY S
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:WOLF
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2088
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-2088
Mailing Address - Country:US
Mailing Address - Phone:907-224-3490
Mailing Address - Fax:907-224-5870
Practice Address - Street 1:31285 WILMA AVENUE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664-3595
Practice Address - Country:US
Practice Address - Phone:907-362-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
AK235813363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No172V00000XOther Service ProvidersCommunity Health Worker