Provider Demographics
NPI:1649228818
Name:WOLKOWSKI, TERESA Q (NP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:Q
Last Name:WOLKOWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E11843 GALL RD
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-8906
Mailing Address - Country:US
Mailing Address - Phone:608-356-4770
Mailing Address - Fax:
Practice Address - Street 1:626 14TH ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1535
Practice Address - Country:US
Practice Address - Phone:608-356-9318
Practice Address - Fax:608-356-9321
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI93956-030163W00000X
WI1055-033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse