Provider Demographics
NPI:1083299267
Name:COATES, JOELLEN
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:
Last Name:COATES
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 1:8820 36TH AVE NE STE 103
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-7268
Mailing Address - Country:US
Mailing Address - Phone:360-718-3098
Mailing Address - Fax:
Practice Address - Street 1:8820 36TH AVE NE STE 103
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-7268
Practice Address - Country:US
Practice Address - Phone:360-718-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1615122300000X
390200000X
WADE61475737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program