Provider Demographics
NPI:1336491646
Name:KOBINAH, MHARAJOY S (APNP)
Entity Type:Individual
Prefix:
First Name:MHARAJOY
Middle Name:S
Last Name:KOBINAH
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:MHARAJOY
Other - Middle Name:G
Other - Last Name:SISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-0639
Mailing Address - Country:US
Mailing Address - Phone:414-247-9005
Mailing Address - Fax:414-247-9004
Practice Address - Street 1:4655 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 325
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1004
Practice Address - Country:US
Practice Address - Phone:414-269-8282
Practice Address - Fax:414-269-8280
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily