Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | ||
Y | 176B00000X | Midwife |
NPI | 1912039504 |
---|---|
Provider Name | Janice Elizabeth Wolfenberg |
First Address | Honesdale, PA 18431-4127 |
Second Address | Honesdale, PA 18431-4127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2007 |
Last Update Date | 10/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6-049 | STATE OF WISCONSIN (01) | WI |