Provider Demographics
NPI: | 1538120456 |
---|---|
Name: | COYNE, ELIZABETH ANN (NP) |
Entity Type: | Individual |
Prefix: | |
First Name: | ELIZABETH |
Middle Name: | ANN |
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: | PO BOX 41555 |
Mailing Address - Street 2: | CHESTNUT HILL EMERGENCY ASSOCIATES LTD |
Mailing Address - City: | PHILADELPHIA |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19101 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-777-2455 |
Mailing Address - Fax: | 610-617-6280 |
Practice Address - Street 1: | 8835 GERMANTOWN AVE |
Practice Address - Street 2: | CHESTNUT HILL HOSPITAL |
Practice Address - City: | PHILADELPHIA |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19118 |
Practice Address - Country: | US |
Practice Address - Phone: | 215-248-8523 |
Practice Address - Fax: | 215-248-8275 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-03-30 |
Last Update Date: | 2014-03-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | TP004187B | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
500028551 | Other | RAILROAD MEDICARE | |
P73945 | Medicare UPIN | ||
PA | 064836 | Medicare ID - Type Unspecified |