Individual
MRS. BONNIE JEAN COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4455 E US ROUTE 36, DECATUR, IL 62521-5003
(217) 588-2600
Mailing address
4965 E LOST BRIDGE RD, DECATUR, IL 62521-5139
(217) 864-5531
(217) 864-2449
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209006142
IL
363LF0000X
Family Nurse Practitioner
Primary
277000529
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102377 1
—
IL
05
—
041292879
—
IL
05
—
1497762959 1
—
IL
01
—
433990
MEDICARE GROUP
IL
01
—
P00678744
RAILROAD MEDICARE
IL
Enumeration date
11/01/2006
Last updated
10/28/2025
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