Provider Demographics
NPI:1922065101
Name:VOLBERDING, ANNETTE M (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:M
Last Name:VOLBERDING
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 1:10438 N PINE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5993
Mailing Address - Country:US
Mailing Address - Phone:262-241-9407
Mailing Address - Fax:
Practice Address - Street 1:10438 N PINE RIDGE CIR
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5993
Practice Address - Country:US
Practice Address - Phone:262-241-9407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-30
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI85163-030163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39841300Medicaid