Provider Demographics
NPI:1861953168
Name:WOLF, EMILY ANNA (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANNA
Last Name:WOLF
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7133 COPPERMILL CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4779
Mailing Address - Country:US
Mailing Address - Phone:812-552-4574
Mailing Address - Fax:
Practice Address - Street 1:7133 COPPERMILL CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4779
Practice Address - Country:US
Practice Address - Phone:812-552-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28229488A163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics