Provider Demographics
NPI:1720787153
Name:WOLFE, MADISON ALEXIS
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ALEXIS
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:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:ALDERSON
Mailing Address - State:WV
Mailing Address - Zip Code:24910-0743
Mailing Address - Country:US
Mailing Address - Phone:540-958-4188
Mailing Address - Fax:
Practice Address - Street 1:86 PENNY LN
Practice Address - Street 2:
Practice Address - City:TALCOTT
Practice Address - State:WV
Practice Address - Zip Code:25951
Practice Address - Country:US
Practice Address - Phone:540-958-4188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant