1609713148 NPI number — MRS. JACQUELYN MICHELLE ANDIE COBREA

Table of content: MRS. JACQUELYN MICHELLE ANDIE COBREA (NPI 1609713148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609713148 NPI number — MRS. JACQUELYN MICHELLE ANDIE COBREA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COBREA
Provider First Name:
JACQUELYN
Provider Middle Name:
MICHELLE ANDIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KILLINGER
Provider Other First Name:
JACQUELYN
Provider Other Middle Name:
MICHELLE ANDIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609713148
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33822 118TH PL SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SULTAN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98294-9673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33822 118TH PL SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SULTAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98294-9673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-778-9766
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374J00000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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