Provider Demographics
NPI:1164821864
Name:COBOZEVA, OLGA (PMHNP-BS)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:COBOZEVA
Suffix:
Gender:F
Credentials:PMHNP-BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PRINCETON ST
Mailing Address - Street 2:STE 203
Mailing Address - City:N CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1558
Mailing Address - Country:US
Mailing Address - Phone:978-256-6579
Mailing Address - Fax:
Practice Address - Street 1:73 PRINCETON ST
Practice Address - Street 2:STE 203
Practice Address - City:N CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1558
Practice Address - Country:US
Practice Address - Phone:978-256-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2267765363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health