Provider Demographics
NPI:1922119023
Name:DOBBS, MIA
Entity Type:Individual
Prefix:MRS
First Name:MIA
Middle Name:
Last Name:DOBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:DOBBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, CNP
Mailing Address - Street 1:20889 JAMESTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8672
Mailing Address - Country:US
Mailing Address - Phone:612-467-3734
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR111949-5282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital