Individual
MRS. DANA LARA WOLFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
16525 FORT ST, SOUTHGATE, MI 48195-1403
(734) 250-9529
Mailing address
23296 STOFLET LN, TRENTON, MI 48183-5408
(843) 250-1895
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2997
SC
363LF0000X
Family Nurse Practitioner
Primary
4704154939
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2997
LICENSE #
SC
01
—
4704154939
LICENSE #
MI
05
—
NP1747
—
SC
01
—
P00906569
RAILROAD MEDICARE PTAN
SC
Enumeration date
07/31/2006
Last updated
07/19/2024
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