Healthcare Provider Details

I. General information

NPI: 1588978092
Provider Name (Legal Business Name): MARJORIE ANN KOBER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E 26TH ST
TACOMA WA
98421-1108
US

IV. Provider business mailing address

101 E 26TH ST
TACOMA WA
98421-1108
US

V. Phone/Fax

Practice location:
  • Phone: 253-597-4550
  • Fax:
Mailing address:
  • Phone: 253-722-1540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberRN00046045
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: