Provider Demographics
NPI:1194461764
Name:WOHLWEND, JENNIFER NICHOLE (NUTRITIONIST MS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:NICHOLE
Last Name:WOHLWEND
Suffix:
Gender:F
Credentials:NUTRITIONIST MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 JEROME ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-1542
Mailing Address - Country:US
Mailing Address - Phone:408-309-0428
Mailing Address - Fax:
Practice Address - Street 1:344 JEROME ST UNIT 2
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-1542
Practice Address - Country:US
Practice Address - Phone:408-309-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty