Provider Demographics
NPI:1740015171
Name:VENABLE WOLFF, CAITLYN JEAN
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:JEAN
Last Name:VENABLE WOLFF
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 1:3304 PRIMROSE DR UNIT 4
Mailing Address - Street 2:
Mailing Address - City:NAVASSA
Mailing Address - State:NC
Mailing Address - Zip Code:28451-2185
Mailing Address - Country:US
Mailing Address - Phone:336-239-4891
Mailing Address - Fax:
Practice Address - Street 1:307 TRENT DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-3038
Practice Address - Country:US
Practice Address - Phone:919-684-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC277619163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology