Provider Demographics
NPI:1841519600
Name:BOBB, YOLANDA DENISE
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:DENISE
Last Name:BOBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 BIVENS ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-4207
Mailing Address - Country:US
Mailing Address - Phone:318-352-5748
Mailing Address - Fax:318-357-4470
Practice Address - Street 1:1506 BIVENS ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-4207
Practice Address - Country:US
Practice Address - Phone:318-352-5748
Practice Address - Fax:318-357-4470
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAYOBOBB347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1340979Medicaid