Provider Demographics
NPI:1306372784
Name:COBURN, NATALY (RN)
Entity Type:Individual
Prefix:
First Name:NATALY
Middle Name:
Last Name:COBURN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 N CONDUIT AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11420-4011
Mailing Address - Country:US
Mailing Address - Phone:929-268-6087
Mailing Address - Fax:
Practice Address - Street 1:1FARMINGDALE ROAD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6235
Practice Address - Country:US
Practice Address - Phone:929-268-6087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY728104163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse