Provider Demographics
NPI:1144070368
Name:WOLF, AMANDA LYNN (RN, WHNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:WOLF
Suffix:
Gender:F
Credentials:RN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10537 FOSSIL HILL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-3950
Mailing Address - Country:US
Mailing Address - Phone:817-936-2552
Mailing Address - Fax:
Practice Address - Street 1:227 TRAVIS RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234
Practice Address - Country:US
Practice Address - Phone:817-936-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132709363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health