Provider Demographics
NPI:1902589930
Name:WOLFF, MELISSA ANN (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:WOLFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 STRATTON ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-4015
Mailing Address - Country:US
Mailing Address - Phone:304-601-5640
Mailing Address - Fax:
Practice Address - Street 1:46 FRIENDLY NEIGHBOR DRIVE
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-855-7104
Practice Address - Fax:304-855-3220
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV75909163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health