1578106365 NPI number — MRS. JENNIFER WOLFE FOX NP-C

Table of content: MRS. JENNIFER WOLFE FOX NP-C (NPI 1578106365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578106365 NPI number — MRS. JENNIFER WOLFE FOX NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOX
Provider First Name:
JENNIFER
Provider Middle Name:
WOLFE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
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:
1578106365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1904 RIP RAP CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23456-6120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-513-6018
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 CLEARFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23462-1815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-457-5100
Provider Business Practice Location Address Fax Number:
757-961-3696
Provider Enumeration Date:
10/24/2019

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: 363L00000X , with the licence number:  0024178131 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1578106365 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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