Provider Demographics
NPI:1841646080
Name:SOBANSKI, REBECCA L (APNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:SOBANSKI
Suffix:
Gender:F
Credentials:APNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2250 E MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3753
Mailing Address - Country:US
Mailing Address - Phone:414-348-8392
Mailing Address - Fax:414-296-8934
Practice Address - Street 1:11431 N PORT WASHINGTON RD STE 260
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3462
Practice Address - Country:US
Practice Address - Phone:414-348-8392
Practice Address - Fax:414-296-8934
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2024-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7047363L00000X
WI7047-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100058723Medicaid