Provider Demographics
NPI:1043425960
Name:PORTER, BOBBI JEAN
Entity Type:Individual
Prefix:MISS
First Name:BOBBI
Middle Name:JEAN
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 TRADE AVE
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1453
Mailing Address - Country:US
Mailing Address - Phone:740-575-4019
Mailing Address - Fax:
Practice Address - Street 1:903 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2856
Practice Address - Country:US
Practice Address - Phone:740-622-0735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide