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General NPI Number Information
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NPI Number | 1083470116
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Entity Type | Individual
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Provider Name | NATHAN DUANE COGBURN FNP
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Gender | Male
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 7 MUNICIPAL WAY
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City | EDGEWOOD
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State | NM
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Zip | 87015-7210
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Country | US
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Telephone | 505-281-3406
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Fax |
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Provider Business Mailing Address
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Address Line | 86B MARTIN LN
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City | MORIARTY
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State | NM
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Zip | 87035-5605
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Country | US
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Telephone | 505-249-8758
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 78111
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License Number State | NM
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