Provider Demographics
NPI:1801264973
Name:MOBERG, CORI ALEX
Entity type:Individual
Prefix:
First Name:CORI
Middle Name:ALEX
Last Name:MOBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 1/2 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4803
Mailing Address - Country:US
Mailing Address - Phone:701-460-1033
Mailing Address - Fax:
Practice Address - Street 1:604 1/2 N 21ST ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4803
Practice Address - Country:US
Practice Address - Phone:701-460-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer