Healthcare Provider Details

I. General information

NPI: 1750583829
Provider Name (Legal Business Name): MARJORIE ALICE WOLFE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8060 KNUE RD SUITE 110
INDIANAPOLIS IN
46250-1976
US

IV. Provider business mailing address

2537 TULIP DR S
INDIANAPOLIS IN
46227-5173
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-7435
  • Fax:
Mailing address:
  • Phone: 317-787-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28093981A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: