Provider Demographics
NPI:1952449936
Name:WOBKEN, LOLA A (RNC, WHNP)
Entity Type:Individual
Prefix:
First Name:LOLA
Middle Name:A
Last Name:WOBKEN
Suffix:
Gender:F
Credentials:RNC, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 WILKES BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4774
Mailing Address - Country:US
Mailing Address - Phone:573-514-7312
Mailing Address - Fax:573-875-8687
Practice Address - Street 1:1123 WILKES BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4774
Practice Address - Country:US
Practice Address - Phone:573-514-7312
Practice Address - Fax:573-875-8687
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO124610363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428150007Medicaid
MO428150007Medicaid
MOP15822Medicare UPIN