Provider Demographics
NPI:1023443173
Name:WOLF, IRENE R (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:R
Last Name:WOLF
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-1224
Mailing Address - Country:US
Mailing Address - Phone:541-942-7000
Mailing Address - Fax:775-738-4918
Practice Address - Street 1:1445 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-1224
Practice Address - Country:US
Practice Address - Phone:541-942-7000
Practice Address - Fax:541-942-7429
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10009004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily