Individual
MS. MICHELE L POLFUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
CHW-FOX VALLEY THEDA CLARK MED CTR, 130 SECOND STREET, NEENAH, WI 54956
(920) 969-7900
Mailing address
130 2ND ST, CHW-FOX VALLEY THEDA CLARK MED CTR, NEENAH, WI 54956-2883
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
1628
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007000261Y
HUMANA
—
05
—
43972900
—
WI
Enumeration date
05/22/2006
Last updated
12/18/2008
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