Provider Demographics
NPI:1124029608
Name:BANDA-WOLK, MARTINE (APNP)
Entity Type:Individual
Prefix:
First Name:MARTINE
Middle Name:
Last Name:BANDA-WOLK
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 DISCOVERY DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5528
Mailing Address - Country:US
Mailing Address - Phone:608-338-0400
Mailing Address - Fax:608-824-8817
Practice Address - Street 1:7601 DISCOVERY DR
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5528
Practice Address - Country:US
Practice Address - Phone:608-338-0400
Practice Address - Fax:608-824-8817
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43810800Medicaid
WI0852480001OtherDMERC
WI500010481OtherRAILROAD MEDICARE