Healthcare Provider Details

I. General information

NPI: 1992712491
Provider Name (Legal Business Name): JANIS COBURN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FOGG RD
WEYMOUTH MA
02190-2432
US

IV. Provider business mailing address

55 FOGG RD
WEYMOUTH MA
02190-2432
US

V. Phone/Fax

Practice location:
  • Phone: 781-624-8321
  • Fax: 781-624-3782
Mailing address:
  • Phone: 781-340-8321
  • Fax: 781-340-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number177871
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: