Provider Demographics
NPI:1043492267
Name:BOBST, MARCELLE (NP)
Entity Type:Individual
Prefix:
First Name:MARCELLE
Middle Name:
Last Name:BOBST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 BURLINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1513
Mailing Address - Country:US
Mailing Address - Phone:859-363-2060
Mailing Address - Fax:859-647-3594
Practice Address - Street 1:7505 BURLINGTON PIKE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1513
Practice Address - Country:US
Practice Address - Phone:859-363-2060
Practice Address - Fax:859-647-3594
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09800363LW0102X
KY3005868363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health