Healthcare Provider Details

I. General information

NPI: 1700779220
Provider Name (Legal Business Name): ELIZABETH RAE DOBBS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W3923 COUNTY ROAD D
MINDORO WI
54644-9506
US

IV. Provider business mailing address

PO BOX 195
MINDORO WI
54644-0195
US

V. Phone/Fax

Practice location:
  • Phone: 608-461-0537
  • Fax:
Mailing address:
  • Phone: 608-461-0537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1114154-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: