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NPI Code Detail

MEDICARE: KRISTEN WOLF

MEDICARE:   KRISTEN  WOLF
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMT21304891IN

General Provider Information

NPI Number : 1073982690
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN WOLF
Provider Business Mailing Address
First Line : 2415 UNION CHAPEL RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-9266
Country : US
Telephone Number : 260-437-0951
Fax Number :
Provider Business Practice Location Address
First Line : 5111 N BEND DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-1753
Country : US
Telephone Number : 260-437-0951
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2015
Last Update Date : 09/24/2015

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Directions to “ KRISTEN WOLF ” Practice Location

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