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NPI Code Detail

MEDICARE: DESHA COBB FNP

MEDICARE: DESHA COBB FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209.012027IL

General Provider Information

NPI Number : 1578951075
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESHA COBB FNP
Provider Business Mailing Address
First Line : 611 W PARK ST
Second Line : FAPC
City : URBANA
State : IL
Zip : 61801-2500
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1302 FRANKLIN AVE STE 1100
Second Line :
City : NORMAL
State : IL
Zip : 61761-0016
Country : US
Telephone Number : 309-268-2727
Fax Number : 309-268-2701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2015
Last Update Date : 12/28/2024

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