Healthcare Provider Details

I. General information

NPI: 1659804698
Provider Name (Legal Business Name): JENNIFER L WOLF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 203
TACOMA WA
98405-5300
US

IV. Provider business mailing address

1708 YAKIMA AVE STE 203
TACOMA WA
98405-5300
US

V. Phone/Fax

Practice location:
  • Phone: 253-382-8150
  • Fax:
Mailing address:
  • Phone: 253-382-8150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD61525595
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD61525595
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: