Provider Demographics
NPI:1275526774
Name:SHOCKEY-WOLL, CATHERINE E (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:E
Last Name:SHOCKEY-WOLL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:UPDIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1687 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-1571
Mailing Address - Country:US
Mailing Address - Phone:715-425-6701
Mailing Address - Fax:715-425-7075
Practice Address - Street 1:1687 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-1571
Practice Address - Country:US
Practice Address - Phone:715-425-6701
Practice Address - Fax:715-425-7075
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1045033363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43951300Medicaid
WI43951300Medicaid
WI0027Medicare ID - Type Unspecified