Provider Demographics
NPI:1871206151
Name:BOBB, INGRID ODACIA (MSN, RN)
Entity type:Individual
Prefix:MS
First Name:INGRID
Middle Name:ODACIA
Last Name:BOBB
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:MS
Other - First Name:INGRID
Other - Middle Name:ODACIA
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NOBLES GLO & ESTHETI
Mailing Address - Street 1:9206 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1718
Mailing Address - Country:US
Mailing Address - Phone:917-650-2492
Mailing Address - Fax:
Practice Address - Street 1:9206 FOSTER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-1718
Practice Address - Country:US
Practice Address - Phone:917-650-2492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0984447163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse