Provider Demographics
NPI:1982451159
Name:COBBLE, ELIANNA KASEY
Entity type:Individual
Prefix:
First Name:ELIANNA
Middle Name:KASEY
Last Name:COBBLE
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 1:11143 ASHLEY RD
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-9761
Mailing Address - Country:US
Mailing Address - Phone:815-409-6889
Mailing Address - Fax:
Practice Address - Street 1:533 S DOLLINGER DR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-4321
Practice Address - Country:US
Practice Address - Phone:815-409-6689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-04
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041553498163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse