Provider Demographics
NPI:1578079943
Name:WOHLFERT, JEANETTE (LPN)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:WOHLFERT
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 1:1390 GEORGE DIETER DR STE 140
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7430
Mailing Address - Country:US
Mailing Address - Phone:915-320-1390
Mailing Address - Fax:
Practice Address - Street 1:1390 GEORGE DIETER DR STE 140
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7430
Practice Address - Country:US
Practice Address - Phone:915-320-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340978164X00000X
NML20579164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse