Healthcare Provider Details

I. General information

NPI: 1841601424
Provider Name (Legal Business Name): LEE ANN COBLE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEE ANN BLACK LPN

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 EAST FRANKLIN STREET
MONROE NC
28112-9339
US

IV. Provider business mailing address

336 W 11TH ST
OAKBORO NC
28129-9339
US

V. Phone/Fax

Practice location:
  • Phone: 704-635-2080
  • Fax:
Mailing address:
  • Phone: 704-244-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number45344
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: