Provider Demographics
NPI:1588733919
Name:WOLFORD, STEPHANIE A (RN, MSN, CNNP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:A
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:RN, MSN, CNNP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:ALBANESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, CNNP
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0329
Mailing Address - Fax:502-588-0326
Practice Address - Street 1:571 S FLOYD ST
Practice Address - Street 2:STE 342
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3818
Practice Address - Country:US
Practice Address - Phone:502-852-8470
Practice Address - Fax:502-852-8473
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005653363LN0005X, 363LN0000X
NC201090363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200933630Medicaid
KY7100073750Medicaid
KY50035389OtherPASSPORT
IN200933630Medicaid