Healthcare Provider Details

I. General information

NPI: 1730316399
Provider Name (Legal Business Name): ELIZABETH E WOLFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 W 12TH ST
PERU IN
46970-1653
US

IV. Provider business mailing address

7100 COMMERCE WAY SUITE 180
BRETNWOOD TN
37027-2851
US

V. Phone/Fax

Practice location:
  • Phone: 765-472-8000
  • Fax:
Mailing address:
  • Phone: 888-304-1116
  • Fax: 615-465-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number37001267A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37001267A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: