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General NPI Number Information
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NPI Number | 1790789063
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Entity Type | Individual
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Provider Name | KATHLEEN LYNN BOBAY RN, PHD
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Gender | Female
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 668 WESTFIELD WAY APT C
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City | PEWAUKEE
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State | WI
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Zip | 53072-6547
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Country | US
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Telephone | 262-695-0545
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Fax |
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Provider Business Mailing Address
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Address Line | 668 WESTFIELD WAY APT C
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City | PEWAUKEE
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State | WI
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Zip | 53072-6547
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Country | US
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Telephone | 262-695-0545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 4704135541
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State | WI
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