Healthcare Provider Details

I. General information

NPI: 1962450379
Provider Name (Legal Business Name): PATRICIA A HOBAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 SIXTH ST
TRAVERSE CITY MI
49684-2345
US

IV. Provider business mailing address

1105 SIXTH ST
TRAVERSE CITY MI
49684-2345
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-6520
  • Fax: 231-935-9116
Mailing address:
  • Phone: 231-935-6520
  • Fax: 231-935-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number170136
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: