Provider Demographics
NPI:1740765734
Name:WOLKING, JANE KAREN
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:KAREN
Last Name:WOLKING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 JENIFER ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3530
Mailing Address - Country:US
Mailing Address - Phone:608-833-9660
Mailing Address - Fax:608-833-4733
Practice Address - Street 1:6514 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1124
Practice Address - Country:US
Practice Address - Phone:608-833-9660
Practice Address - Fax:608-833-4733
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CP002234224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP002344OtherABC PROSTHETICS AND ORTHOTICS