Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209013134 | IL |
NPI | 1003282344 |
---|---|
Provider Name | Joan Marie Cobb |
First Address | Tempe, AZ 85283-1541 |
Second Address | Tempe, AZ 85283 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2015 |
Last Update Date | 27/07/2018 |