Healthcare Provider Details

I. General information

NPI: 1558356733
Provider Name (Legal Business Name): BOBBIE LEDBURY WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 HILLCREST DRIVE
HUDSON WI
54016-4439
US

IV. Provider business mailing address

2651 HILLCREST DRIVE SUITE 303
HUDSON WI
54016-4439
US

V. Phone/Fax

Practice location:
  • Phone: 715-531-6800
  • Fax: 715-531-6801
Mailing address:
  • Phone: 715-531-6800
  • Fax: 715-531-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2486-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: