Provider Demographics
NPI:1629472907
Name:WOHLERS, CAROLYN (RN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:WOHLERS
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 1:1550 E TIERRA GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-3529
Mailing Address - Country:US
Mailing Address - Phone:907-631-3537
Mailing Address - Fax:
Practice Address - Street 1:1550 E TIERRA GRANDE DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-3529
Practice Address - Country:US
Practice Address - Phone:907-631-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101064310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility