Healthcare Provider Details

I. General information

NPI: 1639146665
Provider Name (Legal Business Name): ALICIA WOLF NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 670486
NORTHFIELD OH
44067-0486
US

IV. Provider business mailing address

PO BOX 670486
NORTHFIELD OH
44067-0486
US

V. Phone/Fax

Practice location:
  • Phone: 440-571-0025
  • Fax: 949-695-3229
Mailing address:
  • Phone: 440-571-0025
  • Fax: 949-695-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN.303147
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number08023
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: