Provider Demographics
NPI:1770950867
Name:WOHLFARTH, ALICIA (CNP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WOHLFARTH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:
Practice Address - Street 1:4126 N HOLLAND SYLVANIA RD
Practice Address - Street 2:STE 105
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3536
Practice Address - Country:US
Practice Address - Phone:419-479-5605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17909-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0098364Medicaid
OH0098364Medicaid