Healthcare Provider Details

I. General information

NPI: 1154160133
Provider Name (Legal Business Name): BOBBI VANDAMME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 LUDINGTON ST STE 100
ESCANABA MI
49829-4213
US

IV. Provider business mailing address

3409 LUDINGTON ST STE 100
ESCANABA MI
49829-4213
US

V. Phone/Fax

Practice location:
  • Phone: 906-399-4450
  • Fax:
Mailing address:
  • Phone: 906-789-4414
  • Fax: 906-789-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704300080
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704300080
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704300080
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: