Provider Demographics
NPI:1093822975
Name:WOLLNER, TANYA (APNP)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:WOLLNER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:ZBOROVSKY
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:414-649-3240
Mailing Address - Fax:
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:#525
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-385-2550
Practice Address - Fax:414-649-5414
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129052-030363L00000X
WI2300-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41181700Medicaid