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NPI Code Detail

MEDICARE: ELIZABETH BOHRER PAC

MEDICARE: ELIZABETH BOHRER PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2363A00000XPhysician Assistant4537WI

General Provider Information

NPI Number : 1760963862
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH BOHRER PAC
Provider Business Mailing Address
First Line : 1035 KEPLER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8320
Country : US
Telephone Number : 920-490-9046
Fax Number : 920-405-8005
Provider Business Practice Location Address
First Line : 1110 KEPLER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8306
Country : US
Telephone Number : 920-288-5555
Fax Number : 920-288-5550
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2018
Last Update Date : 12/09/2025

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Directions to “ ELIZABETH BOHRER PAC” Practice Location

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