1245588870 NPI number — MISS JENNIFER LORRAINE WOLFE BHRS

Table of content: MISS JENNIFER LORRAINE WOLFE BHRS (NPI 1245588870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245588870 NPI number — MISS JENNIFER LORRAINE WOLFE BHRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFE
Provider First Name:
JENNIFER
Provider Middle Name:
LORRAINE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BHRS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245588870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
448 36TH ST
Provider Second Line Business Mailing Address:
101
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73072-4743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-573-9905
Provider Business Mailing Address Fax Number:
405-701-0590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
448 36TH ST
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73072-4743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-573-9905
Provider Business Practice Location Address Fax Number:
405-701-0590
Provider Enumeration Date:
08/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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