Provider Demographics
NPI:1083120703
Name:COFFMAN, EILEEN (MS, RD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:BLANCHETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 79137
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0137
Mailing Address - Country:US
Mailing Address - Phone:757-668-9723
Mailing Address - Fax:757-668-9724
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-9723
Practice Address - Fax:757-668-9724
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered