Basic Information
| Provider Information | |||||||||
| NPI: | 1952754632 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DEWOLF | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14890 | ||||||||
| Address2: | SPHP PAYER CREDENTIALING | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185255634 | ||||||||
| FaxNumber: | 5186494094 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 EMPIRE DR STE 100 | ||||||||
| Address2: | CAPITAL REGION FAMILY HEALTH | ||||||||
| City: | RENSSELAER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121445730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182864899 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2016 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 340692 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.