Provider Demographics
NPI:1548428469
Name:BERNICE-WOEHRLE, JILL (LPN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BERNICE-WOEHRLE
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 1:740 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3533
Mailing Address - Country:US
Mailing Address - Phone:201-652-3624
Mailing Address - Fax:
Practice Address - Street 1:740 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3533
Practice Address - Country:US
Practice Address - Phone:201-652-3624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP04567600164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse