Healthcare Provider Details

I. General information

NPI: 1811392780
Provider Name (Legal Business Name): LORI LEE KOBISHOP LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 FRENCH ST
PESHTIGO WI
54157-1204
US

IV. Provider business mailing address

460 FRENCH ST
PESHTIGO WI
54157-1204
US

V. Phone/Fax

Practice location:
  • Phone: 715-923-4559
  • Fax:
Mailing address:
  • Phone: 715-923-4559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number23868-31
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: