Provider Demographics
NPI:1518305382
Name:LANTZ, BOBBIE GEAN (LPN)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:GEAN
Last Name:LANTZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:OH
Mailing Address - Zip Code:43515-1113
Mailing Address - Country:US
Mailing Address - Phone:419-822-4676
Mailing Address - Fax:
Practice Address - Street 1:201 WOOD ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:OH
Practice Address - Zip Code:43515-1113
Practice Address - Country:US
Practice Address - Phone:419-822-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN139025164W00000X
MI4703109682164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse