Provider Demographics
NPI:1184245813
Name:BOBB, ADRIENNE (LPN)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:BOBB
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 1:759 SUSQUEHANNA TRL
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-8109
Mailing Address - Country:US
Mailing Address - Phone:570-538-1240
Mailing Address - Fax:570-538-1530
Practice Address - Street 1:759 SUSQUEHANNA TRL
Practice Address - Street 2:
Practice Address - City:WATSONTOWN
Practice Address - State:PA
Practice Address - Zip Code:17777-8109
Practice Address - Country:US
Practice Address - Phone:570-538-1240
Practice Address - Fax:570-538-1530
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN292760164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse