Staci Ann Bohling
Individual provider Active NPI Registered Nurse · Jackson, WI
NPI 1790129328 · NPPES record last updated Apr 25, 2013
Key facts
- NPI
- 1790129328
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 129608-030 (WI)
- Practice address
- 3189 Twin Creeks Rd
Jackson, WI 53037-8926 - Phone
- (262) 227-1429
- NPI assigned
- Apr 25, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 129608-030 | WI | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 129608-030 | WI | Yes |
Addresses
Primary practice location
3189 Twin Creeks Rd
Jackson, WI 53037-8926
Mailing address
3189 Twin Creeks Rd
Jackson, WI 53037-8926
Phone (262) 227-1429
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All providers in Jackson, WI · Registered Nurse in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.