Healthcare Provider Details

I. General information

NPI: 1104981075
Provider Name (Legal Business Name): BOBBIE JO KEUTEN TAYLOR HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BOBBIE JO KEUTEN HHA

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W 1ST ST
DULUTH MN
55802-1913
US

IV. Provider business mailing address

3004 W 3RD ST
DULUTH MN
55806-1704
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-0053
  • Fax:
Mailing address:
  • Phone: 218-624-5394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: