Individual
SHANTILA NICOLE WOLFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
411 GIBSON LANE, RICHMOND, KY 40475
(859) 626-5030
(859) 626-8020
Mailing address
411 GIBSON LANE, RICHMOND, KY 40475
(859) 626-5030
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/23/2016
Last updated
07/01/2016
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