Provider Demographics
NPI:1114591690
Name:HARBIN, COLEEN (NP)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:HARBIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 NATIONAL PLZ STE 300
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1153
Mailing Address - Country:US
Mailing Address - Phone:301-799-4902
Mailing Address - Fax:
Practice Address - Street 1:137 NATIONAL PLZ STE 300
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1153
Practice Address - Country:US
Practice Address - Phone:301-799-4902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174839363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health