Healthcare Provider Details

I. General information

NPI: 1922343631
Provider Name (Legal Business Name): SHARON A WOLF LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HWY 2 WEST LAKE REGION HUMAN SERVICE CENTER
DEVILS LAKE ND
58301-0650
US

IV. Provider business mailing address

200 HWY 2 WEST LAKE REGION HUMAN SERVICE CENTER
DEVILS LAKE ND
58301
US

V. Phone/Fax

Practice location:
  • Phone: 701-665-2200
  • Fax: 701-665-2300
Mailing address:
  • Phone: 701-665-2200
  • Fax: 701-665-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL6949
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: