Provider Demographics
NPI:1790129328
Name:BOHLING, STACI ANN
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:ANN
Last Name:BOHLING
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 1:3189 TWIN CREEKS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-8926
Mailing Address - Country:US
Mailing Address - Phone:262-227-1429
Mailing Address - Fax:
Practice Address - Street 1:3189 TWIN CREEKS RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037-8926
Practice Address - Country:US
Practice Address - Phone:262-227-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129608-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse