Provider Demographics
NPI:1205218401
Name:COFFEE, CATHY LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:LYNN
Last Name:COFFEE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37312 HARLOW DR
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-5758
Mailing Address - Country:US
Mailing Address - Phone:440-478-9228
Mailing Address - Fax:
Practice Address - Street 1:37312 HARLOW DR
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-5758
Practice Address - Country:US
Practice Address - Phone:440-478-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.129391-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse