Provider Demographics
NPI:1407405566
Name:DURST, BOBBI JO (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:JO
Last Name:DURST
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:MRS
Other - First Name:BOBBI
Other - Middle Name:JO
Other - Last Name:DURST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APNP, PMHNP-BC
Mailing Address - Street 1:25076 KEYESVILLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HILLPOINT
Mailing Address - State:WI
Mailing Address - Zip Code:53937-7432
Mailing Address - Country:US
Mailing Address - Phone:608-604-5657
Mailing Address - Fax:
Practice Address - Street 1:1001 CECELIA DR STE 200
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2500
Practice Address - Country:US
Practice Address - Phone:262-260-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9590-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty