Provider Demographics
NPI:1356723233
Name:WILSON, BOBETTE (RN, CARN)
Entity type:Individual
Prefix:
First Name:BOBETTE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN, CARN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 AIRPORT RD S
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-3510
Mailing Address - Country:US
Mailing Address - Phone:239-227-2839
Mailing Address - Fax:
Practice Address - Street 1:235 AIRPORT RD S
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-3510
Practice Address - Country:US
Practice Address - Phone:239-227-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2011AD873101101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270858731OtherBLUE CROSS/BLUE SHIELD