Healthcare Provider Details

I. General information

NPI: 1245058270
Provider Name (Legal Business Name): MORGAN WOLFE RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W WARM SPRINGS RD STE 136
HENDERSON NV
89014-7636
US

IV. Provider business mailing address

2054 SMOKETREE VILLAGE CIR
HENDERSON NV
89012-3274
US

V. Phone/Fax

Practice location:
  • Phone: 530-391-9958
  • Fax:
Mailing address:
  • Phone: 530-391-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number856968
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: