Provider Demographics
NPI:1962445932
Name:SCHWABE, BOBBI S (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:S
Last Name:SCHWABE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:919 MAIN STREET
Practice Address - Street 2:STE. 102
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311
Practice Address - Country:US
Practice Address - Phone:219-934-2492
Practice Address - Fax:219-934-2493
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000768A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200276410Medicaid
IN499500PPPMedicare PIN
INP 02802Medicare UPIN
IN200276410Medicaid