MEDICARE: MRS. JENNIFER LYNN WOLGAST N.P.

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	363LA2200X	Adult Health Nurse Practitioner	26NN09102100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699819284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LYNN WOLGAST N.P.

Provider Business Mailing Address
First Line	:	411 MOTOR RD
Second Line	:
City	:	PINE BEACH
State	:	NJ
Zip	:	08741-1036
Country	:	US
Telephone Number	:	732-330-0233
Fax Number	:	732-473-0479

Provider Business Practice Location Address
First Line	:	411 MOTOR RD
Second Line	:
City	:	PINE BEACH
State	:	NJ
Zip	:	08741-1036
Country	:	US
Telephone Number	:	732-330-0233
Fax Number	:	732-473-0479

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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