Provider Demographics
NPI:1841742681
Name:MCMAHAN, BOBBIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-2123
Mailing Address - Country:US
Mailing Address - Phone:608-732-0538
Mailing Address - Fax:
Practice Address - Street 1:1120 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-2123
Practice Address - Country:US
Practice Address - Phone:608-732-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI178755-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse