Provider Demographics
NPI:1346736279
Name:WUDTKE, JOLINE (PMHNP)
Entity type:Individual
Prefix:
First Name:JOLINE
Middle Name:
Last Name:WUDTKE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35000 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4825
Mailing Address - Country:US
Mailing Address - Phone:414-534-2929
Mailing Address - Fax:
Practice Address - Street 1:35000 BARTLETT RD
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4825
Practice Address - Country:US
Practice Address - Phone:414-534-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI178716163W00000X
WI8512363LP0808X
WI8512-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse