Provider Demographics
NPI:1538503073
Name:RODRIGUEZ-WISDOM, KARLYE NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:KARLYE
Middle Name:NICOLE
Last Name:RODRIGUEZ-WISDOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARLYE
Other - Middle Name:NICOLE
Other - Last Name:WISDOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11040 N STATE RD 77
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-3606
Mailing Address - Country:US
Mailing Address - Phone:715-934-4910
Mailing Address - Fax:715-934-4620
Practice Address - Street 1:11040 N STATE RD 77
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-3606
Practice Address - Country:US
Practice Address - Phone:715-934-4910
Practice Address - Fax:715-934-4620
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-27
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66025-20207Q00000X
MN58189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine