Provider Demographics
NPI:1144337999
Name:WOELFEL, VICKIE J (NP)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:J
Last Name:WOELFEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:J
Other - Last Name:LIETNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:744 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3505
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:744 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3505
Practice Address - Country:US
Practice Address - Phone:920-433-3784
Practice Address - Fax:920-433-7425
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR147070-7363L00000X
WI3412-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP30777Medicare UPIN