Provider Demographics
NPI:1518669696
Name:KOBOO, EUNICE ROSELINE
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:ROSELINE
Last Name:KOBOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7493 REDBUD LOOP
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3364
Mailing Address - Country:US
Mailing Address - Phone:404-604-4597
Mailing Address - Fax:
Practice Address - Street 1:7493 REDBUD LOOP
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-3364
Practice Address - Country:US
Practice Address - Phone:404-604-4597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203401363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology