=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275390866
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE MARIE BOBKA FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2024
-----------------------------------------------------
Last Update Date | 02/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5475 S 500 E
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84405-6905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-479-2348
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 955 E 2750 N
-----------------------------------------------------
City | NORTH OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84414-2443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-406-9989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 7063398-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------