Provider Demographics
NPI:1740235712
Name:SOBBA, CHERYL K (NP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:K
Last Name:SOBBA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-6296
Mailing Address - Country:US
Mailing Address - Phone:208-459-4667
Mailing Address - Fax:208-459-3372
Practice Address - Street 1:211 E LOGAN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-0000
Practice Address - Country:US
Practice Address - Phone:208-459-4667
Practice Address - Fax:208-459-3372
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN9516363L00000X, 363LF0000X
IDNP 344A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805039300Medicaid
ID1344075Medicare PIN
IDP78492Medicare UPIN
P00376075Medicare PIN