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NPI Code Detail

MEDICARE: EBONY WOLFE NP-C

MEDICARE: EBONY WOLFE NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner86473OK

General Provider Information

NPI Number : 1134679996
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONY WOLFE NP-C
Provider Business Mailing Address
First Line : 9105 NW 90TH CIR
Second Line :
City : YUKON
State : OK
Zip : 73099-5564
Country : US
Telephone Number : 917-805-0864
Fax Number :
Provider Business Practice Location Address
First Line : 1301 SE 59TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73129-7307
Country : US
Telephone Number : 405-632-9631
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2016
Last Update Date : 10/12/2016

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