Provider Demographics
NPI:1356632475
Name:BOBA, MAGDALENA (MS, ANP-BC)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:BOBA
Suffix:
Gender:F
Credentials:MS, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 HAUSER ROSS DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2550 HAUSER ROSS DR
Practice Address - Street 2:SUITE 350
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3149
Practice Address - Country:US
Practice Address - Phone:815-758-7700
Practice Address - Fax:815-756-6103
Is Sole Proprietor?:No
Enumeration Date:2011-04-23
Last Update Date:2016-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008790363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health