Provider Demographics
NPI:1366104804
Name:BROWN, BOBBI JO (NONE)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:JO
Last Name:BROWN
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:JO
Other - Last Name:BROPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:350 CITY VIEW DR STE 206
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5326
Mailing Address - Country:US
Mailing Address - Phone:307-789-7915
Mailing Address - Fax:307-789-6009
Practice Address - Street 1:350 CITY VIEW DR STE 206
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5326
Practice Address - Country:US
Practice Address - Phone:307-789-7915
Practice Address - Fax:307-789-7915
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator