Healthcare Provider Details

I. General information

NPI: 1013615806
Provider Name (Legal Business Name): BOBBIE JANE EMERY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BOBBIE JANE MCCORMICK RN

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W MAIN ST
MARION IL
62959-1188
US

IV. Provider business mailing address

12716 BLACKBERRY HILLS LN
MARION IL
62959-5606
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5311
  • Fax:
Mailing address:
  • Phone: 618-997-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number041343162
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: