Basic Information
| Provider Information | |||||||||
| NPI: | 1750621652 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLF | ||||||||
| FirstName: | LAURA JANE | ||||||||
| MiddleName: | FINLEY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2867 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366522867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516908894 | ||||||||
| FaxNumber: | 2515442188 | ||||||||
| Practice Location | |||||||||
| Address1: | 3810 WULFF RD E | ||||||||
| Address2: | |||||||||
| City: | SEMMES | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365755256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514450582 | ||||||||
| FaxNumber: | 2514450579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2013 | ||||||||
| LastUpdateDate: | 11/28/2018 | ||||||||
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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 | 363LP0200X | 1-121381 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 168845 | 05 | AL | MEDICAID | 163473 | 05 | AL | MEDICAID | 218205 | 05 | AL | MEDICAID | 149920 | 05 | AL | MEDICAID | 164378 | 05 | AL | MEDICAID | 168839 | 05 | AL | MEDICAID | 167060 | 05 | AL | MEDICAID | 150309 | 05 | AL | MEDICAID | 198768 | 05 | AL | MEDICAID |