Provider Demographics
NPI:1346597598
Name:COLBURN, JESSICA CHRISTINE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CHRISTINE
Last Name:COLBURN
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 1:427 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-4751
Mailing Address - Country:US
Mailing Address - Phone:518-569-5730
Mailing Address - Fax:
Practice Address - Street 1:427 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-4751
Practice Address - Country:US
Practice Address - Phone:518-569-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist