Provider Demographics
NPI:1164723938
Name:HYLAND, BOBBI L (LMT)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:L
Last Name:HYLAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90570 NADEAU RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-9744
Mailing Address - Country:US
Mailing Address - Phone:541-913-2425
Mailing Address - Fax:
Practice Address - Street 1:4175 E AMAZON DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4660
Practice Address - Country:US
Practice Address - Phone:541-686-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4707174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist