Provider Demographics
NPI:1205100971
Name:COURSON BIBIN, LAUREN OSBORNE (CNM)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:OSBORNE
Last Name:COURSON BIBIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31636-3457
Mailing Address - Country:US
Mailing Address - Phone:229-834-7506
Mailing Address - Fax:
Practice Address - Street 1:6015 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:GA
Practice Address - Zip Code:31636-3457
Practice Address - Country:US
Practice Address - Phone:229-834-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176291367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife