Provider Demographics
NPI:1295141661
Name:KOBAISSI, ZENA (PA-C)
Entity type:Individual
Prefix:MS
First Name:ZENA
Middle Name:
Last Name:KOBAISSI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17990
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4074
Mailing Address - Country:US
Mailing Address - Phone:910-904-2350
Mailing Address - Fax:910-904-1037
Practice Address - Street 1:313 TEAL DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2567
Practice Address - Country:US
Practice Address - Phone:910-904-2350
Practice Address - Fax:910-904-1037
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04991363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1073638557OtherGOSHEN MEDICAL CENTER