=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194318139
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANNAH WOLFE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2021
-----------------------------------------------------
Last Update Date | 02/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 95-1059 KAAPEHA ST APT 138
-----------------------------------------------------
City | MILILANI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96789-4855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-361-5489
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 95-1059 KAAPEHA ST APT 138
-----------------------------------------------------
City | MILILANI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96789-4855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-361-5489
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | DH044032
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------