| Doctor Name: | MRS. STACIE LORRAINE BOHN |
| NPI Number: | 1568651024 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 17720 |
| Business Practice Address: | 6412 Laurel Ave Lake Isabella, CA - 932409529 |
| Business Phone Number: | 7603791791 |
| Business Fax Number: | 7603791793 |
| Mailing Address: | Po Box 1628, LAKE ISABELLA |
| State: | CA |
| Postal Code: | 932401628 |
| Phone Number: | 7603791791 |
| Fax Number: | 7603791793 |
| NPI Enumeration Date: | 10/22/2007 |
| NPI Last Update Date: | 10/22/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 17720 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |