Provider Demographics
NPI:1609911908
Name:WOLFE-BOHANNON, DORIS MARIE (RN)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:MARIE
Last Name:WOLFE-BOHANNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10198
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-0198
Mailing Address - Country:US
Mailing Address - Phone:760-380-2780
Mailing Address - Fax:
Practice Address - Street 1:WEED ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:BUILDING 170
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-0198
Practice Address - Country:US
Practice Address - Phone:760-380-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR672971163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care