Provider Demographics
NPI:1326075979
Name:KOBASHIGAWA, CAROL ANN (FNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:KOBASHIGAWA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8902 W KATIE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6571
Mailing Address - Country:US
Mailing Address - Phone:702-838-8926
Mailing Address - Fax:705-838-8926
Practice Address - Street 1:3220 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1932
Practice Address - Country:US
Practice Address - Phone:702-878-7776
Practice Address - Fax:702-878-7078
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV412Medicaid