Provider Demographics
NPI:1043561152
Name:COKER, CONNIE LYNN (CNM)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:LYNN
Last Name:COKER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4422
Mailing Address - Country:US
Mailing Address - Phone:845-348-1525
Mailing Address - Fax:845-348-1525
Practice Address - Street 1:150 S BROADWAY
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-4422
Practice Address - Country:US
Practice Address - Phone:845-348-1525
Practice Address - Fax:845-348-1525
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000407-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife