Healthcare Provider Details

I. General information

NPI: 1891226908
Provider Name (Legal Business Name): JOANIE LEE WOLF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 N COUNTY ROAD 25A STE 201
TROY OH
45373-1337
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-703-6090
  • Fax: 937-641-2666
Mailing address:
  • Phone: 937-991-3188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.014370
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: