Provider Demographics
NPI:1073191680
Name:WILSON, BOBBI JEAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BOBBI
Middle Name:JEAN
Last Name:WILSON
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 1:606 CENTRAL CTR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2248
Mailing Address - Country:US
Mailing Address - Phone:740-771-5535
Mailing Address - Fax:740-771-3557
Practice Address - Street 1:606 CENTRAL CTR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2248
Practice Address - Country:US
Practice Address - Phone:740-771-5535
Practice Address - Fax:740-771-3557
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH108263.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse