Provider Demographics
NPI:1447670146
Name:WOLFORD, DANIELLE ANN WOOD (APRN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANN WOOD
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 SOM CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:440-516-8275
Practice Address - Street 1:2550 SOM CENTER RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-9655
Practice Address - Country:US
Practice Address - Phone:440-943-8351
Practice Address - Fax:440-516-8275
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH406455363LA2200X, 363LW0102X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114916Medicaid
OH0114916Medicaid