Provider Demographics
NPI:1447541347
Name:WOLFE, KIMBERLY DENISE (BSN)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DENISE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-1018
Mailing Address - Country:US
Mailing Address - Phone:317-514-3812
Mailing Address - Fax:
Practice Address - Street 1:1776 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-1018
Practice Address - Country:US
Practice Address - Phone:317-514-3812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28190975A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse