Provider Demographics
NPI:1962979062
Name:WOLFSHOHL, KACEY RENE (LVN)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:RENE
Last Name:WOLFSHOHL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4731 KLEIN MDWS
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-9631
Mailing Address - Country:US
Mailing Address - Phone:830-353-7964
Mailing Address - Fax:
Practice Address - Street 1:4731 KLEIN MDWS
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-9631
Practice Address - Country:US
Practice Address - Phone:830-353-7964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342786164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse