Provider Demographics
NPI:1457455149
Name:COYNE, TERESA MARYA (NP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARYA
Last Name:COYNE
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 1:6401 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129
Mailing Address - Country:US
Mailing Address - Phone:440-842-6744
Mailing Address - Fax:
Practice Address - Street 1:23225 LORAIN
Practice Address - Street 2:
Practice Address - City:N OLMSTEAD
Practice Address - State:OH
Practice Address - Zip Code:44070
Practice Address - Country:US
Practice Address - Phone:440-779-6900
Practice Address - Fax:440-779-8091
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06998363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000374980OtherBLUE SHIELD
OHP00222386OtherRR MEDICARE
OH2334067Medicaid
OHCONP10813Medicare ID - Type Unspecified
OHP63188Medicare UPIN