Provider Demographics
NPI:1477805182
Name:WOLF, STELLA PIERCE (RD)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:PIERCE
Last Name:WOLF
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 1:23499 STABLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-6805
Mailing Address - Country:US
Mailing Address - Phone:228-760-0591
Mailing Address - Fax:228-248-4453
Practice Address - Street 1:23499 STABLEWOOD CIR
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-6805
Practice Address - Country:US
Practice Address - Phone:228-760-0591
Practice Address - Fax:228-248-4453
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS800044133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS800044OtherREGISTERED DIETITICIAN