Provider Demographics
NPI:1083862874
Name:COFFEY, CATHERINE M (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:COFFEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OR
Mailing Address - Zip Code:97883-0986
Mailing Address - Country:US
Mailing Address - Phone:541-562-6062
Mailing Address - Fax:
Practice Address - Street 1:142 DEARBORN ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:OR
Practice Address - Zip Code:97883
Practice Address - Country:US
Practice Address - Phone:541-562-6062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450010NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPNP-PP 200450010NPOtherPNP LIC #
OR200342385RNOtherRN