Mallory L Bohling, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

222420-30 Issued in WI

Practice address

835 S Wisconsin Dr
Jefferson, WI 53549-1881

Phone

(920) 573-2222

NPI assigned

Aug 13, 2012

Last updated

Jan 7, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1538416110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 W BLACKHAWK DR",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535383007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 S WISCONSIN DR",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535491881",
            "telephone_number": "920-573-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOHLING",
        "first_name": "MALLORY",
        "middle_name": "L",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-13",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "222420-30",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WI",
            "license": "315895-31",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Myra Braun, MS, LPC-IT, SAC-IT

• Registered Nurse in Jefferson, WI
• Providers in Jefferson, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.