Provider Demographics
NPI:1881947943
Name:WOLF, GABRIEL (RN)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:WOLF
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CAMBRIDGESHIRE CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4682
Mailing Address - Country:US
Mailing Address - Phone:513-405-1989
Mailing Address - Fax:
Practice Address - Street 1:205 CAMBRIDGESHIRE CT
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-4682
Practice Address - Country:US
Practice Address - Phone:513-405-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH342137163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine