Provider Demographics
NPI:1750448478
Name:COLBURN, ROBIN STACEY (CNM)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:STACEY
Last Name:COLBURN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:STACEY
Other - Last Name:WEATHERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 941
Mailing Address - Street 2:
Mailing Address - City:ST. CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302
Mailing Address - Country:US
Mailing Address - Phone:218-640-2647
Mailing Address - Fax:
Practice Address - Street 1:22 WILSON AVE NE STE 205
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-0440
Practice Address - Country:US
Practice Address - Phone:218-640-2647
Practice Address - Fax:320-983-2998
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR176968-3367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN938437000Medicaid
MN938437000Medicaid
MN938437000Medicare ID - Type Unspecified