Provider Demographics
NPI:1225536733
Name:BOBER, AMELYN
Entity Type:Individual
Prefix:
First Name:AMELYN
Middle Name:
Last Name:BOBER
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 1:1229 175TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-8249
Mailing Address - Country:US
Mailing Address - Phone:425-785-5886
Mailing Address - Fax:425-678-8826
Practice Address - Street 1:4132 124TH ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5665
Practice Address - Country:US
Practice Address - Phone:425-785-5886
Practice Address - Fax:425-678-8826
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA751993374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide