Healthcare Provider Details

I. General information

NPI: 1275251233
Provider Name (Legal Business Name): COURTNEY WOLF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 SPINDRIFT DR
WILLIAMSVILLE NY
14221-7894
US

IV. Provider business mailing address

297 SPINDRIFT DR
WILLIAMSVILLE NY
14221-7894
US

V. Phone/Fax

Practice location:
  • Phone: 716-831-2600
  • Fax:
Mailing address:
  • Phone: 716-831-2600
  • Fax: 716-831-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF349030-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: