Provider Demographics
NPI:1275689143
Name:DRODWELL, BOBBIE S (MSN)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:S
Last Name:DRODWELL
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9641 BRANDT AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3024
Mailing Address - Country:US
Mailing Address - Phone:708-692-5521
Mailing Address - Fax:
Practice Address - Street 1:9641 BRANDT AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3024
Practice Address - Country:US
Practice Address - Phone:708-692-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-184063364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical