Provider Demographics
NPI:1003956301
Name:COLBURN, MEGAN (NP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
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 1:3449 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2049
Mailing Address - Country:US
Mailing Address - Phone:219-838-1100
Mailing Address - Fax:
Practice Address - Street 1:3449 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2049
Practice Address - Country:US
Practice Address - Phone:219-838-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28144305A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ42277Medicare UPIN
IN198860CMedicare ID - Type Unspecified