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NPI Code Detail

MEDICARE: MRS. BOBBI PETERSON

MEDICARE: MRS. BOBBI PETERSON
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
1164W00000XLicensed Practical NursePN098489OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811036973
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BOBBI PETERSON
Provider Business Mailing Address
First Line : 5411 NORTON RD
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-8955
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5411 NORTON RD
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-8955
Country : US
Telephone Number : 614-877-1631
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 07/09/2007

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