Provider Demographics
NPI:1154721231
Name:COULBOURN, TRISHA MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:MARIE
Last Name:COULBOURN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:LEMAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:522 CYNWOOD DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3876
Mailing Address - Country:US
Mailing Address - Phone:410-770-5250
Mailing Address - Fax:
Practice Address - Street 1:522 CYNWOOD DR
Practice Address - Street 2:SUITE 300
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3876
Practice Address - Country:US
Practice Address - Phone:410-770-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR165764363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily