Basic Information
| Provider Information | |||||||||
| NPI: | 1376966580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAUL | ||||||||
| FirstName: | BOBBIEJO | ||||||||
| MiddleName: | |||||||||
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| Credential: | APNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GARMS | ||||||||
| OtherFirstName: | BOBBIEJO | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2835 N GRANDVIEW BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PEWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530725546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625742711 | ||||||||
| FaxNumber: | 2625745193 | ||||||||
| Practice Location | |||||||||
| Address1: | 2835 N GRANDVIEW BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PEWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530725546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625742711 | ||||||||
| FaxNumber: | 2625745193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2014 | ||||||||
| LastUpdateDate: | 01/23/2014 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5651-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.