Provider Demographics
NPI:1629628086
Name:WOLBERT, JANELE ALLISON
Entity Type:Individual
Prefix:
First Name:JANELE
Middle Name:ALLISON
Last Name:WOLBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 MONTPELIER AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-1523
Mailing Address - Country:US
Mailing Address - Phone:814-602-2100
Mailing Address - Fax:
Practice Address - Street 1:434 MONTPELIER AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-1523
Practice Address - Country:US
Practice Address - Phone:814-602-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0053392083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RT005339OtherPRECEPTOR