MEDICARE: MRS. STELLA WOHLFARTH FNP-C, MSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95003274	CA
2	163WP2201X	Ambulatory Care Registered Nurse	2021005093	MO
3	163W00000X	Registered Nurse	468363	CA
4	363LF0000X	Family Nurse Practitioner	2021013794	MO

General Provider Information

NPI Number	:	1043670466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STELLA WOHLFARTH FNP-C, MSN

Provider Business Mailing Address
First Line	:	PO BOX 740019
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-0019
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:

Provider Business Practice Location Address
First Line	:	3478 BRIDGELAND DR STE 2
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2619
Country	:	US
Telephone Number	:	314-739-8200
Fax Number	:	314-735-4490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2016
Last Update Date	:	06/26/2026

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