Healthcare Provider Details

I. General information

NPI: 1629995824
Provider Name (Legal Business Name): KATHERINE WOLF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 WASHINGTON DR
ULMAN MO
65083-2028
US

IV. Provider business mailing address

98 WASHINGTON DR
ULMAN MO
65083-2028
US

V. Phone/Fax

Practice location:
  • Phone: 573-280-1619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number3004256013
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: