Provider Demographics
NPI:1386092047
Name:WOLFE, ANN MARIE (RN)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA
Mailing Address - Street 1:1819 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-3932
Mailing Address - Country:US
Mailing Address - Phone:937-831-0526
Mailing Address - Fax:
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:THIRD FLOOR-WOODHAVEN
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3445
Practice Address - Country:US
Practice Address - Phone:937-831-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH383135163W00000X
OH174753101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty