MEDICARE: MR. CHRISTOPHER BRENNAN COBB RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	238485	NC

General Provider Information

NPI Number	:	1275887507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER BRENNAN COBB RN

Provider Business Mailing Address
First Line	:	1997 SINCLAIR TRCE
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-9445
Country	:	US
Telephone Number	:	336-514-5342
Fax Number	:

Provider Business Practice Location Address
First Line	:	1997 SINCLAIR TRCE
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-9445
Country	:	US
Telephone Number	:	336-514-5342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2012
Last Update Date	:	11/08/2012

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