OrganizationRiver Wolf Gynecology & Family Health, PllcNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2104 Banbury Ln, Oklahoma City, OK 73170-3401(405) 203-5382PECOS EnrollmentBased on the most recent information from CMS, provider River Wolf Gynecology & Family Health, Pllc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1205408481Provider TypeOrganizationFull NameRiver Wolf Gynecology & Family Health, PllcSubpartNoEnumeration Date7/15/2021Last Updated7/15/2021Contact InformationPractice LocationPractice Address2104 Banbury Ln, Oklahoma City, OK 73170-3401Phone(405) 203-5382FaxUnlisted FaxMailing LocationMailing Address2104 Banbury Ln, Oklahoma City, OK 73170-3401Phone(405) 203-5382FaxUnlisted FaxAuthorized OfficialNameWolf, Kalli (Owner, Clinician)Phone(405) 203-5382Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerCode367A00000XDescriptionAdvanced Practice MidwifePhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted Issuer