Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4408-33 | WI |
N | 363LP2300X | Nurse Practitioner - Primary Care | 4408-33 | WI |
NPI | 1003100033 |
---|---|
Provider Name | Ms. Kathy Lynne Obermann |
First Address | Medford, WI 54451-1622 |
Second Address | Medford, WI 54451-1622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 15/05/2012 |