Provider Demographics
NPI:1912039504
Name:WOLFENBERG, JANICE ELIZABETH (CPM, LM)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:ELIZABETH
Last Name:WOLFENBERG
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ROCKY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-4127
Mailing Address - Country:US
Mailing Address - Phone:414-313-1464
Mailing Address - Fax:414-877-1174
Practice Address - Street 1:21 ROCKY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-4127
Practice Address - Country:US
Practice Address - Phone:414-313-1464
Practice Address - Fax:414-877-1174
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6-049OtherSTATE OF WISCONSIN