Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | B252-0769-7706-04 | WI |
Y | 213ES0000X | Sports Medicine | B252-0769-7706-04 | WI |
NPI | 1083103857 |
---|---|
Provider Name | Bianca Bockwinkel |
First Address | Middleton, WI 53562-9118 |
Second Address | Madison, WI 53706-1121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2018 |
Last Update Date | 07/05/2018 |