Provider Demographics
NPI:1578727715
Name:COFFMAN, DANA SUE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:SUE
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 47TH ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-3263
Mailing Address - Country:US
Mailing Address - Phone:309-333-9070
Mailing Address - Fax:
Practice Address - Street 1:3400 DEXTER CT
Practice Address - Street 2:SUITE 101
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3461
Practice Address - Country:US
Practice Address - Phone:563-344-6746
Practice Address - Fax:563-344-6740
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD116964367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered