MEDICARE: CHRISTIN TAYLOR WOLFRAM NP

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
1	363LF0000X	Family Nurse Practitioner	0024178073	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407578396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIN TAYLOR WOLFRAM NP

Provider Business Mailing Address
First Line	:	1 PRESTIGE PL STE 550
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-6115
Country	:	US
Telephone Number	:	937-762-1306
Fax Number	:	937-522-7017

Provider Business Practice Location Address
First Line	:	101 E ALEX BELL RD STE 190
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-2752
Country	:	US
Telephone Number	:	937-425-4030
Fax Number	:	937-425-4039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	12/01/2025

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