Provider Demographics
NPI:1073003729
Name:BOBOEVA, SHAKHNOZA (RN)
Entity Type:Individual
Prefix:
First Name:SHAKHNOZA
Middle Name:
Last Name:BOBOEVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W155N11352 SYLVAN CIR APT 20
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3443
Mailing Address - Country:US
Mailing Address - Phone:414-559-4000
Mailing Address - Fax:
Practice Address - Street 1:W155N11352 SYLVAN CIR APT 20
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3443
Practice Address - Country:US
Practice Address - Phone:414-559-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235055-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse