Provider Demographics
NPI:1497718746
Name:WOHL, JENNIFER M (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WOHL
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:STE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4477
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:110 KINGSLEY LANE
Practice Address - Street 2:STE 309, GRANBY INTERNAL MEDICINE PC
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505
Practice Address - Country:US
Practice Address - Phone:757-889-2006
Practice Address - Fax:757-889-6559
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2016-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110840739363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010156629Medicaid
S60036Medicare UPIN
VA010156629Medicaid