1679673461 NPI number — MS. MARTHA JULIA COBB RN FNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679673461 NPI number — MS. MARTHA JULIA COBB RN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COBB
Provider First Name:
MARTHA
Provider Middle Name:
JULIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COBB EILERS
Provider Other First Name:
MARTHA
Provider Other Middle Name:
JULIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN FNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1679673461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
353 JACKSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSBURY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78638-2117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-449-0624
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9900 BREN RD E
Provider Second Line Business Practice Location Address:
MAIL ROUTE MN 008-B213
Provider Business Practice Location Address City Name:
MINNETONKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55343-9664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-449-0624
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2006

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: 363LF0000X , with the licence number:  642399 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 70132711 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 642399 . This is a "BNE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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