Provider Demographics
NPI:1821373416
Name:WOODS-WILNER, BOBBIE JEAN (LMBT)
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:JEAN
Last Name:WOODS-WILNER
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 WB MCLEAN BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CAPE CARTERET
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8522
Mailing Address - Country:US
Mailing Address - Phone:910-787-0775
Mailing Address - Fax:
Practice Address - Street 1:907 WB MCLEAN BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:CAPE CARTERET
Practice Address - State:NC
Practice Address - Zip Code:28584-8522
Practice Address - Country:US
Practice Address - Phone:910-787-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06665225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC06665OtherMASSAGE LICENSE