Provider Demographics
NPI:1104588078
Name:LOVDAHL, BOBBI SUE (APRN)
Entity type:Individual
Prefix:MRS
First Name:BOBBI
Middle Name:SUE
Last Name:LOVDAHL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:SUE
Other - Last Name:PROCHAZKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2406 W 60TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-2725
Mailing Address - Country:US
Mailing Address - Phone:907-830-9151
Mailing Address - Fax:
Practice Address - Street 1:2406 W 60TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-2725
Practice Address - Country:US
Practice Address - Phone:907-830-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA166019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily