Provider Demographics
NPI:1548309065
Name:COBB, DONNA LA JEAN (RN)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LA JEAN
Last Name:COBB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:26037 S RIVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1962
Mailing Address - Country:US
Mailing Address - Phone:313-792-8767
Mailing Address - Fax:313-792-8767
Practice Address - Street 1:33101 ANNAPOLIS ST
Practice Address - Street 2:SUITE B
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2405
Practice Address - Country:US
Practice Address - Phone:734-721-0200
Practice Address - Fax:737-721-2008
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704138249163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health