MEDICARE: BOBIJO STAFFLER FNP

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	363L00000X	Nurse Practitioner	202008469NP-PP	OR

General Provider Information

NPI Number	:	1962001586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBIJO STAFFLER FNP

Provider Business Mailing Address
First Line	:	2850 DAGGETT AVE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1107
Country	:	US
Telephone Number	:	541-274-8610
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 DAGGETT AVE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1107
Country	:	US
Telephone Number	:	541-274-8610
Fax Number	:

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

Provider Enumeration Date	:	10/23/2020
Last Update Date	:	10/28/2022

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Directions to “ BOBIJO STAFFLER FNP” Practice Location

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