Provider Demographics
NPI:1780996082
Name:COBLE, MARY SHANNON (CNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SHANNON
Last Name:COBLE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:618 PLEASANTVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3312
Mailing Address - Country:US
Mailing Address - Phone:740-653-7511
Mailing Address - Fax:740-689-9236
Practice Address - Street 1:618 PLEASANTVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3312
Practice Address - Country:US
Practice Address - Phone:740-653-7511
Practice Address - Fax:740-689-9236
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11592363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health