MEDICARE: KATHLEEN LYNN BOBAY RN, PHD

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
1	163WG0000X	General Practice Registered Nurse	4704135541	MI
2	163WG0000X	General Practice Registered Nurse		WI

General Provider Information

NPI Number	:	1790789063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN LYNN BOBAY RN, PHD

Provider Business Mailing Address
First Line	:	668 WESTFIELD WAY
Second Line	:	APT C
City	:	PEWAUKEE
State	:	WI
Zip	:	53072-6547
Country	:	US
Telephone Number	:	262-695-0545
Fax Number	:

Provider Business Practice Location Address
First Line	:	668 WESTFIELD WAY
Second Line	:	APT C
City	:	PEWAUKEE
State	:	WI
Zip	:	53072-6547
Country	:	US
Telephone Number	:	262-695-0545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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