Individual
COURTNEY E WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1500 N RITTER AVE, INDIANAPOLIS, IN 46219-3027
(317) 274-4779
(317) 948-9806
Mailing address
PO BOX 778912, CHICAGO, IL 60677-8912
(317) 777-6435
(317) 777-6644
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
28154359
IN
363LN0000X
Neonatal Nurse Practitioner
Primary
71002062A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000589162
ANTHEM PROVIDER NUMBER
IN
05
—
200515470
—
IN
01
—
P01221391
RR MEDICARE PTAN
IN
Enumeration date
10/24/2006
Last updated
04/03/2024
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