Provider Demographics
NPI:1730535279
Name:ZUEHLKE, MOLLY ANNE (BS RN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANNE
Last Name:ZUEHLKE
Suffix:
Gender:F
Credentials:BS RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-0130
Mailing Address - Country:US
Mailing Address - Phone:608-776-4800
Mailing Address - Fax:608-776-4919
Practice Address - Street 1:15701 COUNTY RD. D.
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-0130
Practice Address - Country:US
Practice Address - Phone:608-776-4800
Practice Address - Fax:608-776-4919
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WI191426163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No163W00000XNursing Service ProvidersRegistered Nurse