MEDICARE: JENNY WOELK

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	133NN1002X	Nutrition Education Nutritionist	NS12001423	AZ

General Provider Information

NPI Number	:	1639622434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY WOELK

Provider Business Mailing Address
First Line	:	2757 S PEWTER DR
Second Line	:	102
City	:	GILBERT
State	:	AZ
Zip	:	85295-1282
Country	:	US
Telephone Number	:	480-684-0781
Fax Number	:

Provider Business Practice Location Address
First Line	:	2757 S PEWTER DR
Second Line	:	102
City	:	GILBERT
State	:	AZ
Zip	:	85295-1282
Country	:	US
Telephone Number	:	480-684-0781
Fax Number	:

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

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	07/27/2016

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