Healthcare Provider Details

I. General information

NPI: 1679406177
Provider Name (Legal Business Name): BARBARA ANN WALLA OMERNIK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 LIBAL ST
ALLOUEZ WI
54301-2453
US

IV. Provider business mailing address

W3476 HOFA PARK RD
PULASKI WI
54162-8478
US

V. Phone/Fax

Practice location:
  • Phone: 920-445-7373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number147364-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: