Provider Demographics
NPI:1245795301
Name:COCO, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:COCO
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 1:10 TSIENNETO RD
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1505
Mailing Address - Country:US
Mailing Address - Phone:603-434-1577
Mailing Address - Fax:603-434-3101
Practice Address - Street 1:10 TSIENNETO RD
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1505
Practice Address - Country:US
Practice Address - Phone:603-434-1577
Practice Address - Fax:603-434-3101
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH014911-22164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse