Healthcare Provider Details

I. General information

NPI: 1700714938
Provider Name (Legal Business Name): PETE COBRA COBRAITI REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W GOODALE ST APT 458
COLUMBUS OH
43215-1908
US

IV. Provider business mailing address

600 W GOODALE ST APT 458
COLUMBUS OH
43215-1908
US

V. Phone/Fax

Practice location:
  • Phone: 614-477-7228
  • Fax:
Mailing address:
  • Phone: 614-477-7228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number459167
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: