Provider Demographics
NPI:1306232681
Name:COACHMAN, JANIS (LPN)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:COACHMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:
Other - Last Name:CASTONGUAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 1564
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04211-1564
Mailing Address - Country:US
Mailing Address - Phone:207-402-5321
Mailing Address - Fax:
Practice Address - Street 1:1 VA CTR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6719
Practice Address - Country:US
Practice Address - Phone:207-402-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELPN13286164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse