Provider Demographics
NPI:1992155428
Name:BOMKAMP, CARA
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:BOMKAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:704 COZY NEST DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9238
Mailing Address - Country:US
Mailing Address - Phone:954-663-2722
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR STE 1050
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3054
Practice Address - Country:US
Practice Address - Phone:312-642-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018763363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics