MEDICARE: CAITLYN NICOLE WOLFE

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	3747P1801X	Personal Care Attendant	83551	WV

General Provider Information

NPI Number	:	1699369884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLYN NICOLE WOLFE

Provider Business Mailing Address
First Line	:	323 RICHMOND ST
Second Line	:
City	:	KEYSER
State	:	WV
Zip	:	26726-2525
Country	:	US
Telephone Number	:	304-813-0316
Fax Number	:	304-788-6363

Provider Business Practice Location Address
First Line	:	323 RICHMOND ST
Second Line	:
City	:	KEYSER
State	:	WV
Zip	:	26726-2525
Country	:	US
Telephone Number	:	304-813-0316
Fax Number	:	304-788-6363

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

Provider Enumeration Date	:	02/27/2021
Last Update Date	:	02/27/2021

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Directions to “ CAITLYN NICOLE WOLFE ” Practice Location

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