Provider Demographics
NPI:1477526325
Name:COLBURN, GERALDINE ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:ANN
Last Name:COLBURN
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 1:10 SAINT JAMES PL
Mailing Address - Street 2:1007
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-2666
Mailing Address - Country:US
Mailing Address - Phone:603-897-1919
Mailing Address - Fax:
Practice Address - Street 1:214 DANIEL WEBSTER HWY
Practice Address - Street 2:CVS MINUTE CLINIC
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-5504
Practice Address - Country:US
Practice Address - Phone:603-888-4354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA96486363LF0000X
NH047409-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP3297Medicare ID - Type Unspecified
MAQ14895Medicare UPIN