Provider Demographics
NPI:1497760359
Name:ROBACK, DOROTHY JEAN (APNP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JEAN
Last Name:ROBACK
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:JEAN
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W5682 LOVERS RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54437-8317
Mailing Address - Country:US
Mailing Address - Phone:715-937-0718
Mailing Address - Fax:
Practice Address - Street 1:W5682 LOVERS RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:WI
Practice Address - Zip Code:54437-8317
Practice Address - Country:US
Practice Address - Phone:715-937-0718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1035-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily