Basic Information
Provider Information
NPI: 1518590645
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOHLMAN
FirstName: WILLIAM
MiddleName: TODD
NamePrefix: MR.
NameSuffix:  
Credential: APRN, FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1200 WESTWOOD DR
Address2:  
City: HAMILTON
State: MT
PostalCode: 598402345
CountryCode: US
TelephoneNumber: 4063632211
FaxNumber:  
Practice Location
Address1: 1200 WESTWOOD DR
Address2:  
City: HAMILTON
State: MT
PostalCode: 598402345
CountryCode: US
TelephoneNumber: 4063632211
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/17/2020
LastUpdateDate: 07/15/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/15/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XNUR-APRN-LIC-157807MTY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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