Provider Demographics
NPI:1386849735
Name:CORROW, BOBBI LEE (RN)
Entity Type:Individual
Prefix:
First Name:BOBBI LEE
Middle Name:
Last Name:CORROW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 OSBORNE HILL RD
Mailing Address - Street 2:# 28
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-5313
Mailing Address - Country:US
Mailing Address - Phone:845-897-4645
Mailing Address - Fax:
Practice Address - Street 1:52 OSBORNE HILL RD
Practice Address - Street 2:# 28
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-5313
Practice Address - Country:US
Practice Address - Phone:845-897-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY558920-1163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02754016Medicaid