Provider Demographics
NPI:1588653919
Name:OPELT, TINA LOUISE (RN MS CS FNP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LOUISE
Last Name:OPELT
Suffix:
Gender:F
Credentials:RN MS CS FNP
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LOUISE
Other - Last Name:SILBERNAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN MS CS FNP
Mailing Address - Street 1:711 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-5052
Mailing Address - Country:US
Mailing Address - Phone:715-284-3662
Mailing Address - Fax:
Practice Address - Street 1:711 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-5052
Practice Address - Country:US
Practice Address - Phone:715-284-3662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI138024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43947000Medicaid
WI43947000Medicaid