Healthcare Provider Details

I. General information

NPI: 1689283152
Provider Name (Legal Business Name): JESSICA WAHLER DNP, CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 09/21/2020
Certification Date: 09/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 LANES MILL RD
LAKEWOOD NJ
08701-3892
US

IV. Provider business mailing address

1382 LANES MILL RD
LAKEWOOD NJ
08701-3892
US

V. Phone/Fax

Practice location:
  • Phone: 732-994-4242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00072101
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: