MEDICARE: AMANDA COBB RN

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
1	163WC1500X	Community Health Registered Nurse	75905	SC

General Provider Information

NPI Number	:	1821417312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA COBB RN

Provider Business Mailing Address
First Line	:	604 SHADED ACRE CT
Second Line	:
City	:	PELZER
State	:	SC
Zip	:	29669-8956
Country	:	US
Telephone Number	:	864-372-3195
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 UNIVERSITY RDG
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-4712
Country	:	US
Telephone Number	:	864-372-3195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	04/10/2014

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