Provider Demographics
NPI:1710414164
Name:JOHLKE, CHRISTY L (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:JOHLKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 CEDAR BLUFFS WAY APT 15
Mailing Address - Street 2:
Mailing Address - City:SLINGER
Mailing Address - State:WI
Mailing Address - Zip Code:53086-9099
Mailing Address - Country:US
Mailing Address - Phone:920-948-7191
Mailing Address - Fax:
Practice Address - Street 1:990 WOODVIEW CT
Practice Address - Street 2:
Practice Address - City:SLINGER
Practice Address - State:WI
Practice Address - Zip Code:53086-9335
Practice Address - Country:US
Practice Address - Phone:262-644-7356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI232323-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse