Provider Demographics
NPI:1285276337
Name:COBURN, JAMIE (RDN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:COBURN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 N GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PORTER CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12859-1832
Mailing Address - Country:US
Mailing Address - Phone:518-588-4268
Mailing Address - Fax:
Practice Address - Street 1:323 N GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:PORTER CORNERS
Practice Address - State:NY
Practice Address - Zip Code:12859-1832
Practice Address - Country:US
Practice Address - Phone:518-588-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered