Individual
KEELY WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2327 SW 4TH AVE, ONTARIO, OR 97914-1851
(541) 889-2340
Mailing address
2327 SW 4TH AVE, ONTARIO, OR 97914-1851
(541) 889-2340
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
190614
OR
Other
Enumeration date
10/10/2018
Last updated
10/29/2019
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