Individual
MALLORY L BOHLING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
835 S WISCONSIN DR, JEFFERSON, WI 53549-1881
(920) 573-2222
Mailing address
131 W BLACKHAWK DR, FORT ATKINSON, WI 53538-3007
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
222420-30
WI
164W00000X
Licensed Practical Nurse
315895-31
WI
Other
Enumeration date
08/13/2012
Last updated
01/07/2020
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