Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | SP003716G | PA |
NPI | 1003883166 |
---|---|
Provider Name | Jennifer Ruth Bobish |
First Address | Cheswick, PA 15024-0155 |
Second Address | Beaver, PA 15009-2261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 09/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00306441 | RAILROAD MEDICARE (01) | |
S38453 | (02) |