Individual
KEVYN ALEXIS JANICEK WOLLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
535 HOSPITAL RD, NEW RICHMOND, WI 54017-1449
(715) 243-2600
Mailing address
1330 214TH AVE, NEW RICHMOND, WI 54017-1068
(440) 785-4701
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5868-23
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2021
Last updated
08/19/2022
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