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General NPI Number Information
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NPI Number | 1033125802
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Entity Type | Individual
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Provider Name | DANA LARA WOLFE NP-C
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 16525 FORT ST
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City | SOUTHGATE
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State | MI
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Zip | 48195-1403
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Country | US
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Telephone | 734-250-9529
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Fax |
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Provider Business Mailing Address
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Address Line | 23296 STOFLET LN
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City | TRENTON
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State | MI
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Zip | 48183-5408
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Country | US
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Telephone | 843-250-1895
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2997
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704154939
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License Number State | MI
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