Provider Demographics
NPI:1841542347
Name:WOLFE, JANET L
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:L
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 1:4247 WILLOW GLEN LN
Mailing Address - Street 2:APT. D
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-2767
Mailing Address - Country:US
Mailing Address - Phone:317-615-9935
Mailing Address - Fax:
Practice Address - Street 1:4247 WILLOW GLEN LN
Practice Address - Street 2:APT. D
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-2767
Practice Address - Country:US
Practice Address - Phone:317-615-9935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8912-91-2058172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver