Provider Demographics
NPI:1093990368
Name:WOLBRINK, ROSE A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:A
Last Name:WOLBRINK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ROSE
Other - Middle Name:A
Other - Last Name:KULIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:
Practice Address - Street 1:315 W OAK ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-2150
Practice Address - Country:US
Practice Address - Phone:608-269-6731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244325207Q00000X
WI55170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY244325OtherLICENSE
NYRB7541Medicare PIN