Healthcare Provider Details

I. General information

NPI: 1508956830
Provider Name (Legal Business Name): JENNIFER A WOJTOWICZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/02/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 SEASONS RD SUITE 200
HUDSON OH
44224
US

IV. Provider business mailing address

231 SEASONS RD SUITE 200
HUDSON OH
44224
US

V. Phone/Fax

Practice location:
  • Phone: 330-650-5110
  • Fax: 330-650-5115
Mailing address:
  • Phone: 330-650-5110
  • Fax: 330-650-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number34006917
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: