Provider Demographics
NPI:1841601424
Name:COBLE, LEE ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:LEE
Middle Name:ANN
Last Name:COBLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:LEE
Other - Middle Name:ANN
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:336 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28129-9339
Mailing Address - Country:US
Mailing Address - Phone:704-244-0911
Mailing Address - Fax:
Practice Address - Street 1:1408 EAST FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-9339
Practice Address - Country:US
Practice Address - Phone:704-635-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC45344251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health