Healthcare Provider Details

I. General information

NPI: 1629013420
Provider Name (Legal Business Name): JOY KOBISKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 RIVERSIDE DR
WAUPACA WI
54981-1941
US

IV. Provider business mailing address

PO BOX 8003
APPLETON WI
54912-8003
US

V. Phone/Fax

Practice location:
  • Phone: 715-258-1160
  • Fax:
Mailing address:
  • Phone: 920-996-3298
  • Fax: 920-738-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number419
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number419-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: