Individual
BOBBIE KOISTINEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8461 E 4TH ST, TUCSON, AZ 85710-2507
(520) 721-1887
Mailing address
8461 E 4TH ST, TUCSON, AZ 85710-2507
(520) 721-1887
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264058
PROFESSIONAL FOSTER CARE LICENSE
AZ
Enumeration date
09/25/2008
Last updated
09/25/2008
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