Provider Demographics
NPI:1386652055
Name:COBB, VICTORIA LOUISE (NP)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LOUISE
Last Name:COBB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:LOUISE
Other - Last Name:ROHLFING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32 SHADY MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-1215
Mailing Address - Country:US
Mailing Address - Phone:636-498-5183
Mailing Address - Fax:
Practice Address - Street 1:4800 MEXICO RD
Practice Address - Street 2:STE 101
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1666
Practice Address - Country:US
Practice Address - Phone:636-936-0400
Practice Address - Fax:636-936-2252
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO137172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427270301Medicaid
MO427270301Medicaid
MOQ51466Medicare UPIN