Provider Demographics
NPI:1790789063
Name:BOBAY, KATHLEEN LYNN (RN, PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LYNN
Last Name:BOBAY
Suffix:
Gender:F
Credentials:RN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 WESTFIELD WAY
Mailing Address - Street 2:APT C
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-6547
Mailing Address - Country:US
Mailing Address - Phone:262-695-0545
Mailing Address - Fax:
Practice Address - Street 1:668 WESTFIELD WAY
Practice Address - Street 2:APT C
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-6547
Practice Address - Country:US
Practice Address - Phone:262-695-0545
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704135541163WG0000X
WI163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice