Provider Demographics
NPI:1851473680
Name:JROLF, JOEL L
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:L
Last Name:JROLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:
Other - Last Name:JROLF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1700 W PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9795
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13133 N PORT WASHINGTON RD STE G-18
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2420
Practice Address - Country:US
Practice Address - Phone:262-243-5000
Practice Address - Fax:262-243-5317
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1415207V00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2028OtherINTERNAL ID-MOTOR VEHICLE ID
2028OtherINTERNAL ID-MOTOR VEHICLE ID