Provider Demographics
NPI:1003116260
Name:COFFEE, CHRISTINE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:COFFEE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05471-4402
Mailing Address - Country:US
Mailing Address - Phone:802-326-2232
Mailing Address - Fax:
Practice Address - Street 1:38 WHIPPLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH HERO
Practice Address - State:VT
Practice Address - Zip Code:05486-4900
Practice Address - Country:US
Practice Address - Phone:802-372-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0250069494164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse