Healthcare Provider Details

I. General information

NPI: 1043425960
Provider Name (Legal Business Name): MISS BOBBI JEAN PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 MAGNOLIA ST
COSHOCTON OH
43812-2856
US

IV. Provider business mailing address

1536 TRADE AVE
COSHOCTON OH
43812-1453
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-0735
  • Fax:
Mailing address:
  • Phone: 740-575-4019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: