Individual
NICOLE COBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1923 S UTICA AVE, TULSA, OK 74104-6520
(918) 748-7591
(918) 403-6352
Mailing address
1923 S UTICA AVE, TULSA, OK 74104-6520
(918) 748-7591
(918) 403-6352
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3176
OK
Other
Enumeration date
10/14/2019
Last updated
04/03/2020
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