Healthcare Provider Details

I. General information

NPI: 1043505415
Provider Name (Legal Business Name): STEPHANIE MANNING WOLFE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 N ELM ST STE 300
GREENSBORO NC
27401-6312
US

IV. Provider business mailing address

1103 N ELM ST STE 300
GREENSBORO NC
27401-6312
US

V. Phone/Fax

Practice location:
  • Phone: 336-271-3331
  • Fax: 336-271-3724
Mailing address:
  • Phone: 336-271-3331
  • Fax: 336-271-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number174272
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number12612
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: