Coburn, Bonnie Jean

Coburn, Bonnie Jean is an individual health care provider with primary practice located at 4455 E Us Route 36 , Decatur IL 62521-5003. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Coburn, Bonnie Jean can be contacted via phone (217) 588-2600.

Contact Information

Primary practice address
4455 E Us Route 36 Decatur IL 62521-5003
Phone: (217) 588-2600
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209006142 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 277000529 Illinois

Profile Details

NPI number 1720165103
LBN Legal business name Coburn, Bonnie Jean
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 1st, 2006
Last updated Dec 6th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720165103 NPPES
Illinois MEDICAID 041292879
Illinois MEDICAID 036102377 1
Illinois Other 433990
Illinois MEDICAID 1497762959 1
Illinois Other P00678744

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