Healthcare Provider Details

I. General information

NPI: 1023276813
Provider Name (Legal Business Name): JACKIE SUE WOLFE CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15640 N 7TH ST SUITE 6
PHOENIX AZ
85022-3512
US

IV. Provider business mailing address

15640 N 7TH ST SUITE 6
PHOENIX AZ
85022-3512
US

V. Phone/Fax

Practice location:
  • Phone: 602-439-3800
  • Fax: 602-439-3802
Mailing address:
  • Phone: 602-439-3800
  • Fax: 602-439-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number6346
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2278P1005X
TaxonomyPulmonary Rehabilitation Certified Respiratory Therapist
License Number6346
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: