Provider Demographics
NPI:1699872796
Name:KILBORN, DEBORA CORISON (NP)
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:CORISON
Last Name:KILBORN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 MITCHELL DR #223
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-277-1900
Mailing Address - Fax:925-277-1568
Practice Address - Street 1:5201 NORRIS CANYON RD STE 220
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5405
Practice Address - Country:US
Practice Address - Phone:925-277-1900
Practice Address - Fax:925-277-1568
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP13074363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP13074OtherNP LICENSE NUMBER