Provider Demographics
NPI:1326327180
Name:CONNER, BOBBI J (STNA)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:J
Last Name:CONNER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:OH
Mailing Address - Zip Code:43804-9072
Mailing Address - Country:US
Mailing Address - Phone:330-897-6950
Mailing Address - Fax:
Practice Address - Street 1:203 S BUTLER ST
Practice Address - Street 2:
Practice Address - City:BALTIC
Practice Address - State:OH
Practice Address - Zip Code:43804-9072
Practice Address - Country:US
Practice Address - Phone:330-897-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401020131209376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3100503Medicaid