Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 305118 | NY |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 305118 | NY |
N | 363LX0106X | Nurse Practitioner - Occupational Health | 305118 | NY |
NPI | 1083857270 |
---|---|
Provider Name | Mr. Brandon Michael Coburn |
First Address | Buffalo, NY 14224-1971 |
Second Address | Buffalo, NY 14224-1971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2009 |
Last Update Date | 10/02/2015 |