Provider Demographics
NPI:1386850535
Name:STOLTZ, BOBBI ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:BOBBI
Middle Name:ANN
Last Name:STOLTZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:MUSCODA
Mailing Address - State:WI
Mailing Address - Zip Code:53573
Mailing Address - Country:US
Mailing Address - Phone:608-604-0770
Mailing Address - Fax:
Practice Address - Street 1:412 W NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:MUSCODA
Practice Address - State:WI
Practice Address - Zip Code:53573
Practice Address - Country:US
Practice Address - Phone:608-604-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI302835-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35006200Medicaid