Provider Demographics
NPI:1699836130
Name:KASBOHM, FAITH
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:KASBOHM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W MORELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2462
Mailing Address - Country:US
Mailing Address - Phone:262-896-8438
Mailing Address - Fax:262-896-8387
Practice Address - Street 1:615 W MORELAND BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2462
Practice Address - Country:US
Practice Address - Phone:262-896-8438
Practice Address - Fax:262-896-8387
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51202-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse