Healthcare Provider Details

I. General information

NPI: 1073749610
Provider Name (Legal Business Name): BONNIE L OBOIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 S MAIN ST SUITE G
ADAMS WI
53910-9820
US

IV. Provider business mailing address

139 S MAIN ST SUITE G PO BOX 1006
ADAMS WI
53910-9820
US

V. Phone/Fax

Practice location:
  • Phone: 608-339-3151
  • Fax: 608-339-9619
Mailing address:
  • Phone: 608-339-3151
  • Fax: 608-339-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number113935-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: