Healthcare Provider Details

I. General information

NPI: 1073757514
Provider Name (Legal Business Name): LAURA JANE BOBEK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 LORAIN AVE
CLEVELAND OH
44111-5612
US

IV. Provider business mailing address

670 COBBLESTONE DR
AMHERST OH
44001-1966
US

V. Phone/Fax

Practice location:
  • Phone: 216-476-4887
  • Fax:
Mailing address:
  • Phone: 440-985-7559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN 217852
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberNP 06023
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: