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Individual
MR. GORDON COBURN
Active
Individual
MR. GORDON COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, BC
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
0024166489
VA
363LA2200X
Adult Health Nurse Practitioner
11054
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
0024166489
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11054
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1504748
—
TN
05
—
Q008267
—
TN
Enumeration date
11/22/2006
Last updated
04/28/2015
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