Provider Demographics
NPI:1366874489
Name:BISSONETTE, BOBBI JO KAPLA (APNP)
Entity type:Individual
Prefix:MS
First Name:BOBBI JO
Middle Name:KAPLA
Last Name:BISSONETTE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3144 VANZILE ROAD
Mailing Address - Street 2:
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520-8149
Mailing Address - Country:US
Mailing Address - Phone:715-478-5180
Mailing Address - Fax:715-478-5904
Practice Address - Street 1:3144 VANZILE ROAD
Practice Address - Street 2:
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520-8149
Practice Address - Country:US
Practice Address - Phone:715-478-5180
Practice Address - Fax:715-478-5904
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5361-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100031339Medicaid