Provider Demographics
NPI:1033741871
Name:COFFEE, CAROLYN A
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:COFFEE
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 1:1305 ALLMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AK
Mailing Address - Zip Code:99585
Mailing Address - Country:US
Mailing Address - Phone:907-679-6226
Mailing Address - Fax:907-679-6659
Practice Address - Street 1:1305 ALLMAN AVENUE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AK
Practice Address - Zip Code:99585
Practice Address - Country:US
Practice Address - Phone:907-679-6226
Practice Address - Fax:907-679-6659
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker