Provider Demographics
NPI:1326719469
Name:ROLF, JOHANNA
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:
Last Name:ROLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W BROWN DEER RD STE N
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2367
Mailing Address - Country:US
Mailing Address - Phone:414-446-4038
Mailing Address - Fax:
Practice Address - Street 1:333 W BROWN DEER RD STE N
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:WI
Practice Address - Zip Code:53217-2367
Practice Address - Country:US
Practice Address - Phone:414-446-4038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date: