MEDICARE: MRS. NICOLE LYNN WOCELKA LM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	49-116	WI

General Provider Information

NPI Number	:	1225293814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE LYNN WOCELKA LM

Provider Business Mailing Address
First Line	:	3212 E 37TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2618
Country	:	US
Telephone Number	:	612-590-9033
Fax Number	:

Provider Business Practice Location Address
First Line	:	3212 E 37TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2618
Country	:	US
Telephone Number	:	612-590-9033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2008
Last Update Date	:	06/15/2015

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