MRS. BONNIE JEAN COBURN (NPI# 1720165103) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720165103 |
| Entity Type | Individual |
| Full Name | MRS. BONNIE JEAN COBURN |
| Credential | NP |
| Practice Address |
200 Dettro Dr Mattoon IL 61938-9003 |
| Mailing Address |
1005 Health Center Dr Ste 201 Mattoon IL 61938-4653 |
| Practice Telephone | 2172383000 |
| Practice Fax Number | 2172383008 |
| Mailing Telephone | 2172582581 |
| Mailing Fax Number | 2172582216 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-07-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 209006142 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
277000529 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 1497762959 1 | 05 | |
| IL | MEDICARE GROUP | 433990 | 01 |
| IL | 036102377 1 | 05 | |
| IL | RAILROAD MEDICARE | P00678744 | 01 |
| IL | 041292879 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2040 Lincoln Ave Ste 100, Charleston, IL 619203197 | 2173452030 | 2173452045 |
| 1100 Tuscola Blvd, Tuscola, IL 619532065 | 2172534764 | 2172534886 |
| Street Address |
200 DETTRO DR |
| City | MATTOON |
| State | IL |
| Zip Code | 61938-9003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124586565 | Ashley Adams | Nurse Practitioner | 200 Dettro Dr, Mattoon, IL 61938-9003 | 2019-03-05 |
| 1710433529 | Leah Teichmiller | Physician Assistant | 200 Dettro Dr, Mattoon, IL 61938 | 2016-08-31 |
| 1104218247 | Amanda Stroud | Nurse Practitioner | 200 Dettro Dr, Mattoon, IL 61938 | 2015-02-26 |
| 1639444110 | Janette S Marciano | Physician Assistant | 200 Dettro Dr, Mattoon, IL 61938-9003 | 2012-03-15 |
| 1568747822 | Jessica Lynn Mathenia | Physician Assistant | 200 Dettro Dr, Mattoon, IL 61938-9003 | 2011-10-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043831134 | St Anthony's Memorial Hospital of The Hospital Sisters of The Third Or | Clinic/Center | 101 Coles Centre Pkwy, Ste 101, Mattoon, IL 61938 | 2020-04-30 |
| 1215436449 | Sarah Bush Lincoln Health Center | Durable Medical Equipment & Medical Supplies | 300 Coles Centre Pkwy, Mattoon, IL 61938 | 2018-02-02 |
| 1841707726 | Mattoon Chiropractic LLC | Chiropractor | 905 Remington Rd, Mattoon, IL 61938 | 2018-01-02 |
| 1164892758 | Dr. Charles L. Schnibben Ltd. | Dentist | 1502 Lakeland Blvd, Mattoon, IL 61938 | 2015-09-25 |
| 1982000139 | Judy A. Clark | Hearing Instrument Specialist | 1302 Charleston Avenue, Audibel Hearing Aids, Mattoon, IL 61938 | 2014-11-17 |
| 1023419884 | Christopher Steven Lillie | Physician Assistant | 200 Richmond Ave East, Family Medical Center, Mattoon, IL 61938 | 2014-09-11 |
| 1295055168 | Jennifer Harp | Mechanotherapist | 232 Richmond Ave East, Mattoon, IL 61938 | 2010-06-02 |
| 1447482682 | Gene Clark Hearing Aid Service | Hearing Aid Equipment | 208 Wabash, Mattoon, IL 61938 | 2009-08-21 |
| 1326229774 | Central Illinois Family Health Center | Nurse Practitioner | 10555 East County Rd 800 North, Mattoon, IL 61938 | 2007-11-14 |
| 1568656445 | Bernie Ranchero | Family Medicine | 1004 Health Center Dr Ste 210, Mattoon, IL 61938 | 2007-09-04 |
| Find all providers in zip 61938 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013541143 | Matya Leann Riley | Nurse Practitioner | 1005 N 32nd St, Mattoon, IL 61938-2236 | 2020-02-27 |
| 1194270603 | Christa Lynne Metzelaars | Nurse Practitioner | 700 Broadway Ave E Ste 39, Mattoon, IL 61938-4662 | 2016-08-25 |
| 1033484704 | Bella Family Health and Wellness, LLC | Nurse Practitioner | 10555 E County Road 800n, Mattoon, IL 61938-3574 | 2012-03-14 |
| 1326229774 | Central Illinois Family Health Center | Nurse Practitioner | 10555 East County Rd 800 North, Mattoon, IL 61938 | 2007-11-14 |
| 1679676738 | Kelli Lynn Blagg | Nurse Practitioner | 10555 East County Road 800 N, Mattoon, IL 61938-3574 | 2006-09-06 |
| 1215992805 | Mary H Mcguire | Nurse Practitioner | 700 Broadway Ave E, Suite 39, Mattoon, IL 61938-4671 | 2006-04-18 |
| 1043867419 | Emily N Hardiek | Nurse Practitioner | 2512 Hurst Dr Ste 130, Mattoon, IL 61938-9200 | 2019-08-21 |
| 1861943011 | Jean Sandercock | Nurse Practitioner | 1000 Health Center Dr, Mattoon, IL 61938-9261 | 2016-10-21 |
| 1851847867 | Lyndsay Chevalier | Nurse Practitioner | 1004 Health Center Dr, Suite 212, Mattoon, IL 61938-9253 | 2016-08-30 |
| 1104218247 | Amanda Stroud | Nurse Practitioner | 200 Dettro Dr, Mattoon, IL 61938 | 2015-02-26 |
| Find all providers in MATTOON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.