Provider Demographics
NPI:1275873689
Name:COATNEY, CONNIE L (LPN)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:L
Last Name:COATNEY
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 1:904 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2193
Mailing Address - Country:US
Mailing Address - Phone:217-347-2255
Mailing Address - Fax:217-342-6910
Practice Address - Street 1:904 MEDICAL PARK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2193
Practice Address - Country:US
Practice Address - Phone:217-347-2255
Practice Address - Fax:217-342-6910
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043076500164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse