Provider Demographics
NPI:1043600745
Name:BOHN, JILL (APNP, FNP-BC, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:BOHN
Suffix:
Gender:F
Credentials:APNP, FNP-BC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-4306
Mailing Address - Country:US
Mailing Address - Phone:715-424-8600
Mailing Address - Fax:
Practice Address - Street 1:419 N OAK ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:WI
Practice Address - Zip Code:53910-9401
Practice Address - Country:US
Practice Address - Phone:608-339-5250
Practice Address - Fax:608-339-5252
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6136-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily