Provider Demographics
NPI:1548241110
Name:COBLE-ROE, CONNIE (CRNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:COBLE-ROE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LOTHROP ST
Mailing Address - Street 2:FORBES TOWER, SUITE 10055-B
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2536
Mailing Address - Country:US
Mailing Address - Phone:412-647-3222
Mailing Address - Fax:412-647-3222
Practice Address - Street 1:5 SAINT FRANCIS WAY
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-5119
Practice Address - Country:US
Practice Address - Phone:724-814-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP003875B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001879072Medicaid
PA001879072Medicaid
PA004967EVQMedicare ID - Type Unspecified