Healthcare Provider Details

I. General information

NPI: 1861449217
Provider Name (Legal Business Name): NINA WOKHLU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S WEBSTER AVE
GREEN BAY WI
54301-3528
US

IV. Provider business mailing address

200 E WASHINGTON ST P O BOX 8031
APPLETON WI
54911-5490
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-3640
  • Fax: 920-433-3716
Mailing address:
  • Phone: 888-505-0558
  • Fax: 920-739-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number48832-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: