Provider Demographics
NPI:1780728725
Name:BOBST, MARILYNN JEAN (RN, RAS)
Entity type:Individual
Prefix:MS
First Name:MARILYNN
Middle Name:JEAN
Last Name:BOBST
Suffix:
Gender:F
Credentials:RN, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47190 GOLDEN BUSH CT
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-6078
Mailing Address - Country:US
Mailing Address - Phone:760-702-4122
Mailing Address - Fax:
Practice Address - Street 1:47190 GOLDEN BUSH CT
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-6078
Practice Address - Country:US
Practice Address - Phone:760-702-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB0409231235101YA0400X
CA326239163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)