Provider Demographics
NPI:1023222460
Name:COFFEE, NANCY M (SFIDC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:COFFEE
Suffix:
Gender:F
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24392 STOTTLEMEYER RD NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8846
Mailing Address - Country:US
Mailing Address - Phone:360-475-4981
Mailing Address - Fax:
Practice Address - Street 1:1 BOONE ROAD
Practice Address - Street 2:NAVAL HOSPITAL BREMERTON
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312
Practice Address - Country:US
Practice Address - Phone:360-475-4981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman