Provider Demographics
NPI:1639982853
Name:WOLF, JESSICA LYNN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:WOLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2987 HWY 51 DECATURE NEBRASKA
Mailing Address - Street 2:P.O BOX 53
Mailing Address - City:DECATUR
Mailing Address - State:NE
Mailing Address - Zip Code:68020-0053
Mailing Address - Country:US
Mailing Address - Phone:402-870-0453
Mailing Address - Fax:
Practice Address - Street 1:2987 HWY 51 DECATURE NEBRASKA
Practice Address - Street 2:P.O BOX 53
Practice Address - City:DECATUR
Practice Address - State:NE
Practice Address - Zip Code:68020-0053
Practice Address - Country:US
Practice Address - Phone:402-870-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide