Provider Demographics
NPI:1194134205
Name:WOLF, CINDY D (LPN)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:D
Last Name:WOLF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-6081
Mailing Address - Country:US
Mailing Address - Phone:920-342-1898
Mailing Address - Fax:
Practice Address - Street 1:1020 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-6081
Practice Address - Country:US
Practice Address - Phone:920-342-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310953-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse