Individual
KIM I WOLTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, RN, CHPN, PHN
Contact information
Practice address
615 5TH ST, BROOKINGS, OR 97415-9199
(541) 813-2535
Mailing address
PO BOX 810, GOLD BEACH, OR 97444-0810
(541) 813-2353
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201704864RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201704864RN
LICENSE
OR
Enumeration date
09/21/2017
Last updated
09/21/2017
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