Healthcare Provider Details

I. General information

NPI: 1033790324
Provider Name (Legal Business Name): JANE E WOJAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2021
Last Update Date: 04/18/2021
Certification Date: 04/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E DAVIS DR
TERRE HAUTE IN
47802-4183
US

IV. Provider business mailing address

1330 CANDLEWOOD CIR
TERRE HAUTE IN
47802-9351
US

V. Phone/Fax

Practice location:
  • Phone: 812-242-4600
  • Fax:
Mailing address:
  • Phone: 812-249-6492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number473311
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: