Provider Demographics
NPI:1306121835
Name:SULLINS, BOBBIE J (CNA)
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:J
Last Name:SULLINS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13302 CAINE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6330
Mailing Address - Country:US
Mailing Address - Phone:216-882-0518
Mailing Address - Fax:
Practice Address - Street 1:13302 CAINE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-6330
Practice Address - Country:US
Practice Address - Phone:216-882-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3651918390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program