Provider Demographics
NPI:1023381266
Name:BOHN, ADRIENNE K (PA-C)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:K
Last Name:BOHN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 WESTOWNE DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2175
Mailing Address - Country:US
Mailing Address - Phone:920-720-8200
Mailing Address - Fax:
Practice Address - Street 1:1136 WESTOWNE DR
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2175
Practice Address - Country:US
Practice Address - Phone:920-720-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2897-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100021524Medicaid