Provider Demographics
NPI:1477925048
Name:COFFIN, JESSUP
Entity Type:Individual
Prefix:
First Name:JESSUP
Middle Name:
Last Name:COFFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 NE 73RD PL
Mailing Address - Street 2:APT. #6
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3621 NE 73RD PL
Practice Address - Street 2:APT. #6
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5958
Practice Address - Country:US
Practice Address - Phone:206-612-8697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula