Provider Demographics
NPI:1235528647
Name:WAMSLEY, NICOLETTE (HIS)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:WAMSLEY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:NICOLETTE
Other - Middle Name:PEARL
Other - Last Name:SYBELDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:623 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095
Mailing Address - Country:US
Mailing Address - Phone:262-334-4232
Mailing Address - Fax:262-334-5443
Practice Address - Street 1:623 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3228
Practice Address - Country:US
Practice Address - Phone:262-334-4232
Practice Address - Fax:262-334-5443
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1457237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist