Healthcare Provider Details

I. General information

NPI: 1043943129
Provider Name (Legal Business Name): SAMANTHA WOLLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 WATERTOWN PLANK RD
MILWAUKEE WI
53226-3548
US

IV. Provider business mailing address

7710 MERCY RD STE 202 CU-DEPARTMENT OF INTERNAL MEDICINE
OMAHA NE
68124-2353
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-8733
  • Fax:
Mailing address:
  • Phone: 402-208-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number37034
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9416
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: