MEDICARE: PATRICIA 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
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1285562298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA WOLF

Provider Business Mailing Address
First Line	:	6733 NAVIGATOR DR
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-9311
Country	:	US
Telephone Number	:	217-898-8734
Fax Number	:

Provider Business Practice Location Address
First Line	:	6733 NAVIGATOR DR
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-9311
Country	:	US
Telephone Number	:	217-898-8734
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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