Provider Demographics
NPI:1033278007
Name:WOLFF, JEANETTE LOUISE (CNM)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:LOUISE
Last Name:WOLFF
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:100 WEST RD
Practice Address - Street 2:SUITE 404
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2331
Practice Address - Country:US
Practice Address - Phone:410-832-5511
Practice Address - Fax:410-832-5560
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR115859367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD994LMedicare UPIN
MD369559YYKMedicare PIN