Provider Demographics
NPI:1477140101
Name:BOBO, BROOKE RASHELLE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:RASHELLE
Last Name:BOBO
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 1:301 N MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:43107-1033
Mailing Address - Country:US
Mailing Address - Phone:740-438-3966
Mailing Address - Fax:
Practice Address - Street 1:301 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:OH
Practice Address - Zip Code:43107-1033
Practice Address - Country:US
Practice Address - Phone:740-438-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant