Healthcare Provider Details

I. General information

NPI: 1649454141
Provider Name (Legal Business Name): CHRIS C WALVIK R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28537 263 ST
HOLCOMBE WI
54745-0233
US

IV. Provider business mailing address

PO BOX 233
HOLCOMBE WI
54745-0233
US

V. Phone/Fax

Practice location:
  • Phone: 715-577-1086
  • Fax:
Mailing address:
  • Phone: 715-577-1086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number132583-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: