Individual
KIM WOLLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
319 QUAW AVE, EDGAR, WI 54426-9316
(715) 352-3593
Mailing address
319 QUAW AVE, EDGAR, WI 54426-9316
(715) 352-3593
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
221487
WI
164X00000X
Licensed Vocational Nurse
318084
WI
Other
Enumeration date
11/17/2014
Last updated
03/12/2015
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