Provider Demographics
NPI:1528482106
Name:COBURN, KAREN (IBCLC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:COBURN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 W FEAGIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-2717
Mailing Address - Country:US
Mailing Address - Phone:936-239-2447
Mailing Address - Fax:
Practice Address - Street 1:807 W FEAGIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-2717
Practice Address - Country:US
Practice Address - Phone:936-239-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244871163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant