Provider Demographics
NPI:1245690148
Name:WOHLHETER, JENNIFER HAVEN (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HAVEN
Last Name:WOHLHETER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2366
Mailing Address - Country:US
Mailing Address - Phone:740-202-3076
Mailing Address - Fax:
Practice Address - Street 1:1033 KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2366
Practice Address - Country:US
Practice Address - Phone:740-202-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.106590-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse