Provider Demographics
NPI:1619168580
Name:WESTPHAL, NOLA R (MD)
Entity Type:Individual
Prefix:
First Name:NOLA
Middle Name:R
Last Name:WESTPHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2598 730TH ST.
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-6613
Mailing Address - Country:US
Mailing Address - Phone:715-664-8256
Mailing Address - Fax:
Practice Address - Street 1:N2598 730TH ST.
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-6613
Practice Address - Country:US
Practice Address - Phone:715-664-8256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37082-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine