Provider Demographics
NPI:1285403691
Name:WOLFE, ANGEL LEA
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:LEA
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 BUSHYHEAD ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5640
Mailing Address - Country:US
Mailing Address - Phone:918-316-5965
Mailing Address - Fax:
Practice Address - Street 1:16414 W 760 RD
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-1675
Practice Address - Country:US
Practice Address - Phone:918-708-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist