=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639146665
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALICIA WOLF NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2006
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 85 3RD ST SE
-----------------------------------------------------
City | BARBERTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44203-4208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-666-6457
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 670486
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44067-0486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-666-6457
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | RN.303147
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 12273
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 201359
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 08023
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------