Healthcare Provider Details

I. General information

NPI: 1174627400
Provider Name (Legal Business Name): JESSICA HOBERG CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA WITT

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 W LINCOLN AVE ROGERS MEMORIAL HOSPITAL
WEST ALLIS WI
53227
US

IV. Provider business mailing address

3630 N HICKORY LANE
OCONOMOWOC WI
53066
US

V. Phone/Fax

Practice location:
  • Phone: 414-327-3000
  • Fax:
Mailing address:
  • Phone: 262-646-1338
  • Fax: 262-646-7067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number246333
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: