Healthcare Provider Details

I. General information

NPI: 1629584610
Provider Name (Legal Business Name): ERIN ELIZABETH WOLFF PA-C
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 269
ANIAK AK
99557-0269
US

IV. Provider business mailing address

PO BOX 269
ANIAK AK
99557-0269
US

V. Phone/Fax

Practice location:
  • Phone: 907-675-4556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number194408
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: