Healthcare Provider Details

I. General information

NPI: 1164539789
Provider Name (Legal Business Name): LAURA M HOBBS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E COMMERCE ST
ELKHORN WI
53121
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 262-723-3100
  • Fax: 262-723-3438
Mailing address:
  • Phone: 414-647-6326
  • Fax: 414-671-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number614-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: