Provider Demographics
NPI:1396064564
Name:WOLTHERS, VIVIANE EJLERS (AP, RN)
Entity type:Individual
Prefix:MRS
First Name:VIVIANE
Middle Name:EJLERS
Last Name:WOLTHERS
Suffix:
Gender:F
Credentials:AP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SW 75TH TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3211
Mailing Address - Country:US
Mailing Address - Phone:954-850-1093
Mailing Address - Fax:
Practice Address - Street 1:5173 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-4508
Practice Address - Country:US
Practice Address - Phone:954-850-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9167415163W00000X
FLAP2714171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse