Provider Demographics
NPI:1710246111
Name:WOOLFLPN, DEBRA MADONNA (LPN)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:MADONNA
Last Name:WOOLFLPN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7449 W BECKETT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1011
Mailing Address - Country:US
Mailing Address - Phone:414-616-1578
Mailing Address - Fax:
Practice Address - Street 1:7449 W BECKETT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1011
Practice Address - Country:US
Practice Address - Phone:414-616-1578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28164-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse