Provider Demographics
NPI:1205577632
Name:MOBLEY, ANNA (ICCE, CLC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:ICCE, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 93RD DR NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-3415
Mailing Address - Country:US
Mailing Address - Phone:805-857-4717
Mailing Address - Fax:
Practice Address - Street 1:1234 93RD DR NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-3415
Practice Address - Country:US
Practice Address - Phone:805-857-4717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator