Provider Demographics
NPI:1851175699
Name:NORDQUIST, VIDALLAH MULLEY (DNP)
Entity Type:Individual
Prefix:
First Name:VIDALLAH
Middle Name:MULLEY
Last Name:NORDQUIST
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:VIDALLAH
Other - Middle Name:MULLEY
Other - Last Name:NORDQUIST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-387-5511
Mailing Address - Fax:
Practice Address - Street 1:3400 MINISTRY PKWY
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5220
Practice Address - Country:US
Practice Address - Phone:715-393-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14480-33363LG0600X
WI230193-30363LG0600X, 363L00000X
WI14480363L00000X
WI230193163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse