Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 28144305A | IN |
NPI | 1003956301 |
---|---|
Provider Name | Megan Colburn |
First Address | Highland, IN 46322-2049 |
Second Address | Highland, IN 46322-2049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q42277 | (02) | IN |