Healthcare Provider Details

I. General information

NPI: 1447654405
Provider Name (Legal Business Name): JEFFREY S WOLF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 05/06/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31285 WILMA AVENUE
SEWARD AK
99664-3595
US

IV. Provider business mailing address

PO BOX 2088
SEWARD AK
99664-2088
US

V. Phone/Fax

Practice location:
  • Phone: 907-362-4341
  • Fax:
Mailing address:
  • Phone: 907-224-3490
  • Fax: 907-224-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number235813
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: