Provider Demographics
NPI:1255722070
Name:WOLFF, TRACI (RN)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:WOLFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:KRZANOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:W9888 STATE HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-9331
Mailing Address - Country:US
Mailing Address - Phone:715-846-0306
Mailing Address - Fax:
Practice Address - Street 1:W9888 STATE HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-9331
Practice Address - Country:US
Practice Address - Phone:715-846-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19811-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse