Provider Demographics
NPI:1407825144
Name:BOBAK, LESSA A (RNRCS)
Entity Type:Individual
Prefix:MRS
First Name:LESSA
Middle Name:A
Last Name:BOBAK
Suffix:
Gender:F
Credentials:RNRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-2223
Mailing Address - Country:US
Mailing Address - Phone:608-329-6951
Mailing Address - Fax:
Practice Address - Street 1:1004 29TH AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-2223
Practice Address - Country:US
Practice Address - Phone:608-329-6951
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38266300Medicaid