Provider Demographics
NPI:1649417064
Name:PRIEBE KOBYLINSKI, NICOLE ANN
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANN
Last Name:PRIEBE KOBYLINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:PRIEBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12300 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-3710
Mailing Address - Country:US
Mailing Address - Phone:216-581-9641
Mailing Address - Fax:
Practice Address - Street 1:12300 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3710
Practice Address - Country:US
Practice Address - Phone:216-581-9641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2810917OtherOHIO MEDICAID LEGACY NUMBER