Active NPI
Nickey Louis Wolff, L.A.T.
- Athletic Trainer
- Sussex, WI
National Provider Identifier
1225187610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 95-039
- Practice address
- N63W23075 State Highway 74
Sussex, WI 53089-2876 - Phone
- (414) 566-4586
- Fax
- (414) 566-4640
- NPI assigned
- Jan 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 95-039 | WI | Primary |
Addresses
Primary practice location
N63W23075 State Highway 74
Sussex, WI 53089-2876
Mailing address
2757 N 74TH St
Wauwatosa, WI 53210-1009
Phone (414) 774-2658
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 95-039 | Other | WI | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95-039 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225187610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2757 N 74TH ST",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532101009",
"telephone_number": "414-774-2658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N63W23075 STATE HIGHWAY 74",
"city": "SUSSEX",
"state": "WI",
"postal_code": "530892876",
"telephone_number": "414-566-4586",
"fax_number": "414-566-4640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLFF",
"first_name": "NICKEY",
"middle_name": "LOUIS",
"credential": "L.A.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "95-039",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "95-039",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sussex, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.