Basic Information
| Provider Information | |||||||||
| NPI: | 1336182955 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLTERS | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 218 | ||||||||
| Address2: | 2600 65TH AVENUE | ||||||||
| City: | OSCEOLA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540203024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152942111 | ||||||||
| FaxNumber: | 7152942111 | ||||||||
| Practice Location | |||||||||
| Address1: | 1925 WOODWINDS DR | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551254445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512320228 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 03/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 49636 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | 25771 | AZ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 53721 | WI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.