Provider Demographics
NPI:1619223146
Name:STALLBOHM, ALLISON L (APNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:L
Last Name:STALLBOHM
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:L
Other - Last Name:GEBHEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-1846
Mailing Address - Country:US
Mailing Address - Phone:920-730-4414
Mailing Address - Fax:
Practice Address - Street 1:1501 S MADISON ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1846
Practice Address - Country:US
Practice Address - Phone:920-730-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI144714363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner