Provider Demographics
NPI:1700286796
Name:WOLFE, LAURA LEE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:WOLFE
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 1:22580 HIGHWAY 76 E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-8439
Mailing Address - Country:US
Mailing Address - Phone:864-939-1070
Mailing Address - Fax:864-939-1079
Practice Address - Street 1:22580 HIGHWAY 76 E
Practice Address - Street 2:SUITE 300
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-8439
Practice Address - Country:US
Practice Address - Phone:864-939-1070
Practice Address - Fax:864-939-1079
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17833363LF0000X
SC19078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily