Healthcare Provider Details

I. General information

NPI: 1841194040
Provider Name (Legal Business Name): WOLFANGEL WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W GLENROSA AVE STE 104
PHOENIX AZ
85013-3374
US

IV. Provider business mailing address

635 W GLENROSA AVE STE 104
PHOENIX AZ
85013-3374
US

V. Phone/Fax

Practice location:
  • Phone: 602-625-7944
  • Fax: 833-471-5960
Mailing address:
  • Phone: 602-625-7944
  • Fax: 833-471-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRAVIS WOLFANGEL
Title or Position: OWNDER
Credential: DNP
Phone: 314-346-5524