Provider Demographics
NPI:1831410117
Name:WOOLF, KATHLEEN (PHD, RD)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:WOOLF
Suffix:
Gender:F
Credentials:PHD, RD
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 14148
Mailing Address - Street 2:WOOLF NUTRITION, LLC
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85216
Mailing Address - Country:US
Mailing Address - Phone:480-215-9981
Mailing Address - Fax:
Practice Address - Street 1:1920 E. CAMBRIDGE AVE, SUITE 301
Practice Address - Street 2:ARIZONA PEDIATRIC CARDIOLOGY CONSULTANTS
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:480-215-9981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0713391133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered