Basic Information
| Provider Information | |||||||||
| NPI: | 1912415068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLF | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | JANE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3737 SOUTHERN BLVD STE 4200 | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454290135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372941489 | ||||||||
| FaxNumber: | 9372947999 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 BURNET AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8598020759 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2018 | ||||||||
| LastUpdateDate: | 11/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | RN.425121 | OH | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363LF0000X | APRN.CNP.024338 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.