Provider Demographics
NPI:1114626561
Name:KOHLEPP, JUSTINE (LPN)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:KOHLEPP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-1797
Mailing Address - Country:US
Mailing Address - Phone:215-426-8100
Mailing Address - Fax:267-861-6410
Practice Address - Street 1:2100 N FRONT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-1705
Practice Address - Country:US
Practice Address - Phone:215-425-8100
Practice Address - Fax:267-861-6410
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN295851164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30-037-307OtherDRIVER'S LICENSE