Healthcare Provider Details

I. General information

NPI: 1467461624
Provider Name (Legal Business Name): PEGGY RUTH COBB CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6441 W 81ST ST
TULSA OK
74131-3432
US

IV. Provider business mailing address

6441 W 81ST ST
TULSA OK
74131-3432
US

V. Phone/Fax

Practice location:
  • Phone: 918-224-1605
  • Fax: 918-224-1605
Mailing address:
  • Phone: 918-224-1605
  • Fax: 918-224-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: