Provider Demographics
NPI:1912492398
Name:WOHLRABE, HEIDI RUTH (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:RUTH
Last Name:WOHLRABE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:HEIDI
Other - Middle Name:RUTH
Other - Last Name:RIVERON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1010 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-5012
Mailing Address - Country:US
Mailing Address - Phone:715-581-4073
Mailing Address - Fax:
Practice Address - Street 1:1010 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5012
Practice Address - Country:US
Practice Address - Phone:715-581-4073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI384782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry