Provider Demographics
NPI:1659138857
Name:BOBADILLA, BLANCA M (FNP)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:M
Last Name:BOBADILLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2557 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3405
Mailing Address - Country:US
Mailing Address - Phone:414-517-5907
Mailing Address - Fax:
Practice Address - Street 1:1710 S 7TH ST STE 300
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3538
Practice Address - Country:US
Practice Address - Phone:844-493-1052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2023168832363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care