Provider Demographics
NPI:1285205088
Name:WOLF, JENNIFER (RN, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15902 TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:UPPERCO
Mailing Address - State:MD
Mailing Address - Zip Code:21155-9519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15902 TRENTON RD
Practice Address - Street 2:
Practice Address - City:UPPERCO
Practice Address - State:MD
Practice Address - Zip Code:21155-9519
Practice Address - Country:US
Practice Address - Phone:443-821-5681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR145467163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant