Provider Demographics
NPI:1104981075
Name:KEUTEN TAYLOR, BOBBIE JO (HHA)
Entity type:Individual
Prefix:MRS
First Name:BOBBIE JO
Middle Name:
Last Name:KEUTEN TAYLOR
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:MS
Other - First Name:BOBBIE JO
Other - Middle Name:
Other - Last Name:KEUTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HHA
Mailing Address - Street 1:3004 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-1704
Mailing Address - Country:US
Mailing Address - Phone:218-624-5394
Mailing Address - Fax:
Practice Address - Street 1:227 W 1ST ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1913
Practice Address - Country:US
Practice Address - Phone:218-722-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide