Provider Demographics
NPI:1639782865
Name:BENCH, BOBBIE JO
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JO
Last Name:BENCH
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 1:4952 JOES CR RD
Mailing Address - Street 2:
Mailing Address - City:COMORT
Mailing Address - State:WV
Mailing Address - Zip Code:25049
Mailing Address - Country:US
Mailing Address - Phone:304-549-0391
Mailing Address - Fax:
Practice Address - Street 1:4952 JOES CR RD
Practice Address - Street 2:
Practice Address - City:COMORT
Practice Address - State:WV
Practice Address - Zip Code:25049
Practice Address - Country:US
Practice Address - Phone:304-549-0391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant