Healthcare Provider Details

I. General information

NPI: 1417397456
Provider Name (Legal Business Name): BOBBIJO P MINGER X
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S MCKINLEY AVE
ALLIANCE OH
44601-2363
US

IV. Provider business mailing address

105 S MCKINLEY AVE
ALLIANCE OH
44601-2363
US

V. Phone/Fax

Practice location:
  • Phone: 330-581-8093
  • Fax:
Mailing address:
  • Phone: 330-581-8093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number373729900394
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: