Provider Demographics
NPI:1184758765
Name:HOELTER, JENNY SUE WING (MD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:SUE WING
Last Name:HOELTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1794 COURT ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4326
Mailing Address - Country:US
Mailing Address - Phone:971-239-5284
Mailing Address - Fax:
Practice Address - Street 1:891 23RD ST NE
Practice Address - Street 2:CHILDHOOD HEALTH ASSOCIATES OF SALEM
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-364-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27426208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics