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 today at 10:58 AM.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