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NPI Code Detail

MEDICARE: JESSICA WOLFRAM RN

MEDICARE: JESSICA WOLFRAM RN
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
1163WA0400XAddiction (Substance Use Disorder) Registered NurseRN.521683OH

General Provider Information

NPI Number : 1225678170
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA WOLFRAM RN
Provider Business Mailing Address
First Line : 4900 GLENWAY AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-3916
Country : US
Telephone Number : 513-435-0379
Fax Number :
Provider Business Practice Location Address
First Line : 4900 GLENWAY AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-3916
Country : US
Telephone Number : 513-435-0379
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2020
Last Update Date : 09/18/2025

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