Provider Demographics
NPI:1629243829
Name:WOLLMANN, MARTIN J
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:J
Last Name:WOLLMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-0829
Mailing Address - Country:US
Mailing Address - Phone:360-354-8641
Mailing Address - Fax:360-354-8649
Practice Address - Street 1:1713 N CASCADE WAY
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1084
Practice Address - Country:US
Practice Address - Phone:360-354-8641
Practice Address - Fax:360-354-8649
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00142064246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular