MEDICARE: NATHANIEL BOBB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WD0400X	Diabetes Educator Registered Nurse	4704348892	MI

General Provider Information

NPI Number	:	1245199215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL BOBB

Provider Business Mailing Address
First Line	:	9793 MYERS LAKE AVE NE
Second Line	:
City	:	ROCKFORD
State	:	MI
Zip	:	49341-9508
Country	:	US
Telephone Number	:	517-881-9769
Fax Number	:

Provider Business Practice Location Address
First Line	:	9793 MYERS LAKE AVE NE
Second Line	:
City	:	ROCKFORD
State	:	MI
Zip	:	49341-9508
Country	:	US
Telephone Number	:	517-881-9769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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