Provider Demographics
NPI:1063660249
Name:BOBB, AMANDA JO (LPN)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:JO
Last Name:BOBB
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37083 STATE ROUTE 93
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:OH
Mailing Address - Zip Code:45634-8894
Mailing Address - Country:US
Mailing Address - Phone:740-577-1549
Mailing Address - Fax:
Practice Address - Street 1:37083 STATE ROUTE 93
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:OH
Practice Address - Zip Code:45634-8894
Practice Address - Country:US
Practice Address - Phone:740-577-1549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-30
Last Update Date:2008-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 118364 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse