Provider Demographics
NPI:1427124478
Name:HERRON, BOBBI JEAN (MS,APRN,BC-CNS)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:JEAN
Last Name:HERRON
Suffix:
Gender:F
Credentials:MS,APRN,BC-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-9556
Mailing Address - Country:US
Mailing Address - Phone:219-464-7032
Mailing Address - Fax:219-947-6863
Practice Address - Street 1:1500 S LAKE PARK AVE
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6638
Practice Address - Country:US
Practice Address - Phone:219-947-6823
Practice Address - Fax:219-947-6863
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000162A364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN64434Medicare UPIN
IN940400SSMedicare ID - Type Unspecified