Provider Demographics
NPI:1184074791
Name:COBO, ANN MARIE (LPN)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:COBO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:14703 ALDRICH ST. EXT
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070
Mailing Address - Country:US
Mailing Address - Phone:716-345-7583
Mailing Address - Fax:
Practice Address - Street 1:14703 ALDRICH ST
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070
Practice Address - Country:US
Practice Address - Phone:716-345-7583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317380-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse