Provider Demographics
NPI:1730282732
Name:PIBURN, JOANN C (FNP)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:C
Last Name:PIBURN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8121
Mailing Address - Country:US
Mailing Address - Phone:970-298-5864
Mailing Address - Fax:970-298-5888
Practice Address - Street 1:1050 WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8121
Practice Address - Country:US
Practice Address - Phone:970-298-5864
Practice Address - Fax:970-298-5888
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO56621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
273058Medicare ID - Type Unspecified
S55183Medicare UPIN