Provider Demographics
NPI:1447593454
Name:WOLFGRAM, NICOLE M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:WOLFGRAM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 N SHORE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-6710
Mailing Address - Country:US
Mailing Address - Phone:715-361-2000
Mailing Address - Fax:715-361-2762
Practice Address - Street 1:2251 N SHORE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-6710
Practice Address - Country:US
Practice Address - Phone:715-361-2000
Practice Address - Fax:715-361-2762
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5249-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily