Basic Information
| Provider Information | |||||||||
| NPI: | 1194089144 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLF | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 N KEENE ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652018104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738173096 | ||||||||
| FaxNumber: | 5738176645 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 N KEENE ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652016986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734996084 | ||||||||
| FaxNumber: | 5734996085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2012 | ||||||||
| LastUpdateDate: | 06/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 2012019692 | MO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.