Provider Demographics
NPI:1265003255
Name:WOOLVERTON, MEREDITH ANN
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANN
Last Name:WOOLVERTON
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 1:720 N OLD WORLD 3RD ST APT 310
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-2251
Mailing Address - Country:US
Mailing Address - Phone:503-593-5237
Mailing Address - Fax:
Practice Address - Street 1:1111 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1810
Practice Address - Country:US
Practice Address - Phone:414-312-8146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist