Provider Demographics
NPI:1558604660
Name:HARTER, BOBBIE JEAN (CMA)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JEAN
Last Name:HARTER
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1204
Mailing Address - Country:US
Mailing Address - Phone:740-504-1907
Mailing Address - Fax:
Practice Address - Street 1:4 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1204
Practice Address - Country:US
Practice Address - Phone:740-504-1907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2411918374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide