Individual
MIKAELA GLORIA VOLLMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14353 STATE HIGHWAY 32 64, MOUNTAIN, WI 54149-9656
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5759-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100197885
—
WI
Enumeration date
03/16/2022
Last updated
04/22/2024
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