Provider Demographics
NPI:1699422394
Name:COBURN, EULA M
Entity type:Individual
Prefix:
First Name:EULA
Middle Name:M
Last Name:COBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115A N 24TH PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6607
Mailing Address - Country:US
Mailing Address - Phone:414-882-1452
Mailing Address - Fax:
Practice Address - Street 1:4115A N 24TH PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-6607
Practice Address - Country:US
Practice Address - Phone:414-882-1452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor