Provider Demographics
NPI:1881494060
Name:COBBS, BRUSHA
Entity type:Individual
Prefix:
First Name:BRUSHA
Middle Name:
Last Name:COBBS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5324 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-2242
Mailing Address - Country:US
Mailing Address - Phone:402-594-9436
Mailing Address - Fax:
Practice Address - Street 1:5324 FOWLER AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2242
Practice Address - Country:US
Practice Address - Phone:402-594-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor