Provider Demographics
NPI:1336024108
Name:WOLLA, VERA
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:WOLLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:TIOGA
Mailing Address - State:ND
Mailing Address - Zip Code:58852-0361
Mailing Address - Country:US
Mailing Address - Phone:701-641-3486
Mailing Address - Fax:
Practice Address - Street 1:401 S DAKOTA ST
Practice Address - Street 2:
Practice Address - City:TIOGA
Practice Address - State:ND
Practice Address - Zip Code:58852-7412
Practice Address - Country:US
Practice Address - Phone:701-641-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty