Provider Demographics
NPI:1467793968
Name:COATES, JUDITH ROSE (CRNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ROSE
Last Name:COATES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:LONG POND
Mailing Address - State:PA
Mailing Address - Zip Code:18334-7858
Mailing Address - Country:US
Mailing Address - Phone:570-643-9766
Mailing Address - Fax:
Practice Address - Street 1:DISCOVERY DRIVE
Practice Address - Street 2:
Practice Address - City:SWIFTWATER
Practice Address - State:PA
Practice Address - Zip Code:18370
Practice Address - Country:US
Practice Address - Phone:570-649-5761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily