Basic Information
| Provider Information | |||||||||
| NPI: | 1033864368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLF | ||||||||
| FirstName: | KATLYN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 HOPE DR | ||||||||
| Address2: | |||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170332036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175310003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 941 PARK DR | ||||||||
| Address2: | |||||||||
| City: | PALMYRA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170783445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178386305 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2022 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | RN672987 | PA | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.