Healthcare Provider Details

I. General information

NPI: 1699146662
Provider Name (Legal Business Name): PATRICIA ANNE KOBA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA ANNE BRESNAK CRNP

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND AVE STE 220
BETHLEHEM PA
18017-9310
US

IV. Provider business mailing address

1417 8TH AVE
BETHLEHEM PA
18018-2256
US

V. Phone/Fax

Practice location:
  • Phone: 610-868-1100
  • Fax:
Mailing address:
  • Phone: 484-526-5210
  • Fax: 484-526-5237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP015571
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: