Provider Demographics
NPI:1770231946
Name:VOLLMAR, MIKAELA GLORIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:GLORIA
Last Name:VOLLMAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MIKAELA
Other - Middle Name:GLORIA
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:W2453 LINDQUIST RD
Mailing Address - Street 2:
Mailing Address - City:CECIL
Mailing Address - State:WI
Mailing Address - Zip Code:54111-9380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2845 GREENBRIER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:920-288-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5759-23207P00000X
WI5759363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine