Provider Demographics
NPI:1649342197
Name:COBB, YVETTE (NP)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 LEWIS CT
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6817
Mailing Address - Country:US
Mailing Address - Phone:248-593-5584
Mailing Address - Fax:248-593-9929
Practice Address - Street 1:502 LEWIS CT
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6817
Practice Address - Country:US
Practice Address - Phone:248-593-5584
Practice Address - Fax:248-593-9929
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704250380363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily