Healthcare Provider Details

I. General information

NPI: 1316751472
Provider Name (Legal Business Name): VICTORIA COBB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 MISSILE AVE
MINOT AFB ND
58705-5024
US

IV. Provider business mailing address

194 MISSILE AVE
MINOT AFB ND
58705-5024
US

V. Phone/Fax

Practice location:
  • Phone: 701-723-5633
  • Fax:
Mailing address:
  • Phone: 701-723-5633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: