Provider Demographics
NPI:1215814108
Name:WOLTER, ELIZABETH ANNETTE ROBYN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNETTE ROBYN
Last Name:WOLTER
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 1:105 CHATFIELD ST S
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55929-1620
Mailing Address - Country:US
Mailing Address - Phone:507-273-9535
Mailing Address - Fax:
Practice Address - Street 1:401 16TH ST SE STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-7974
Practice Address - Country:US
Practice Address - Phone:507-516-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program