MEDICARE: CALVIN JOHN COGBURN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP30007600	WA

General Provider Information

NPI Number	:	1184764284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALVIN JOHN COGBURN ARNP

Provider Business Mailing Address
First Line	:	PO BOX 915
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-0915
Country	:	US
Telephone Number	:	360-969-0915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 SE CITY BEACH ST
Second Line	:	UNIT 915
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-7009
Country	:	US
Telephone Number	:	360-969-0915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/06/2015

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