Healthcare Provider Details

I. General information

NPI: 1922065101
Provider Name (Legal Business Name): ANNETTE M VOLBERDING R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10438 N PINE RIDGE CIR
MEQUON WI
53092-5993
US

IV. Provider business mailing address

10438 N PINE RIDGE CIR
MEQUON WI
53092-5993
US

V. Phone/Fax

Practice location:
  • Phone: 262-241-9407
  • Fax:
Mailing address:
  • Phone: 262-241-9407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number85163-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: