Healthcare Provider Details

I. General information

NPI: 1518376144
Provider Name (Legal Business Name): VANESSA COBLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W ELM ST
GRAHAM NC
27253-2158
US

IV. Provider business mailing address

540 W ELM ST
GRAHAM NC
27253-2158
US

V. Phone/Fax

Practice location:
  • Phone: 336-227-0730
  • Fax: 336-227-0732
Mailing address:
  • Phone: 336-227-0730
  • Fax: 336-227-0732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number01040
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number01040
License Number StateNC

VIII. Authorized Official

Name: DR. VANESSA COBLE
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 336-227-0730