MEDICARE: MRS. TERESA Q WOLKOWSKI NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	93956-030	WI
2	363LA2200X	Adult Health Nurse Practitioner	1055-033	WI

General Provider Information

NPI Number	:	1649228818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA Q WOLKOWSKI NP

Provider Business Mailing Address
First Line	:	E11843 GALL RD
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913-8906
Country	:	US
Telephone Number	:	608-356-4770
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 14TH ST
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913-1535
Country	:	US
Telephone Number	:	608-356-9318
Fax Number	:	608-356-9321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	11/20/2009

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