Provider Demographics
NPI:1447251442
Name:WOLTER, MARGARET-ELIZABETH R (NP)
Entity type:Individual
Prefix:MRS
First Name:MARGARET-ELIZABETH
Middle Name:R
Last Name:WOLTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:E ROSINA
Other - Last Name:WOLTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 776982
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6982
Mailing Address - Country:US
Mailing Address - Phone:231-672-2119
Mailing Address - Fax:313-432-7759
Practice Address - Street 1:6401 PRAIRIE ST STE 2600
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-7842
Practice Address - Country:US
Practice Address - Phone:231-672-7900
Practice Address - Fax:231-672-7931
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704212017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1447251442Medicaid
0P04040001Medicare ID - Type Unspecified