Provider Demographics
NPI:1104502756
Name:WOLKEN, SYDNEY MAKHAEL
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MAKHAEL
Last Name:WOLKEN
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 1:2611 ANNA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-4495
Mailing Address - Country:US
Mailing Address - Phone:308-530-4439
Mailing Address - Fax:
Practice Address - Street 1:220 W LEOTA ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6293
Practice Address - Country:US
Practice Address - Phone:308-568-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant