Provider Demographics
NPI:1053611236
Name:DANNIECE BOBECHE MSN WHNP PLLC
Entity type:Organization
Organization Name:DANNIECE BOBECHE MSN WHNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANNIECE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBECHE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:361-834-7459
Mailing Address - Street 1:15405 FORTUNA BAY DR
Mailing Address - Street 2:5
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6383
Mailing Address - Country:US
Mailing Address - Phone:361-985-0906
Mailing Address - Fax:361-985-6981
Practice Address - Street 1:5525 S STAPLES ST
Practice Address - Street 2:B1
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5357
Practice Address - Country:US
Practice Address - Phone:361-985-0906
Practice Address - Fax:361-985-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248781363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191386501Medicaid
TX8Y1954OtherBLUE CROSS BLUE SHIELD
TX191386501Medicaid