| Doctor Name: | MRS. JENNIFER LISA WOLVERTON-WADE |
| NPI Number: | 1093064685 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, CWCN |
| License Number: | RN9333023 |
| Business Practice Address: | 3000 41st St Marathon, FL - 33050 |
| Business Phone Number: | 3054347660 |
| Business Fax Number: | |
| Mailing Address: | 210 Key Honey Lane, TAVERNIER |
| State: | FL |
| Postal Code: | 33070 |
| Phone Number: | 8603280013 |
| Fax Number: | |
| NPI Enumeration Date: | 08/29/2012 |
| NPI Last Update Date: | 08/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0809X |
| License Number: | RN9333023 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |