Active NPI
Carla Roxann Wolfrum, LD
- Denturist
- Sandpoint, ID
National Provider Identifier
1609045681
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Denturist
- License
- LD9
- Practice address
- 204 E Superior St
Suite #9
Sandpoint, ID 83864-1275 - Phone
- (208) 255-5577
- Fax
- (208) 255-5577
- NPI assigned
- Feb 25, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Denturist | 122400000X | LD9 | ID | Primary |
Addresses
Primary practice location
204 E Superior St
Suite #9
Sandpoint, ID 83864-1275
Mailing address
204 E Superior St
Suite #9
Sandpoint, ID 83864-1275
Phone (208) 255-5577
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD9 | ID | MD | Denturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203897600000",
"number": "1609045681",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 E SUPERIOR ST",
"address_2": "SUITE #9",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838641275",
"telephone_number": "208-255-5577",
"fax_number": "208-255-5577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 E SUPERIOR ST",
"address_2": "SUITE #9",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838641275",
"telephone_number": "208-255-5577",
"fax_number": "208-255-5577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLFRUM",
"first_name": "CARLA",
"middle_name": "ROXANN",
"name_prefix": "Ms.",
"credential": "LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-25",
"last_updated": "2008-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "122400000X",
"taxonomy_group": "",
"desc": "Denturist",
"state": "ID",
"license": "LD9",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sandpoint, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.