Provider Demographics
NPI:1598868689
Name:COFFEEN-CARLEY, MARY ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:COFFEEN-CARLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:COFFEEN-CARLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FAMILY NURSE PRACTIT
Mailing Address - Street 1:PO BOX 1728
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82931-1728
Mailing Address - Country:US
Mailing Address - Phone:386-697-9279
Mailing Address - Fax:
Practice Address - Street 1:831 ST. HIGHWAY, 150 SOUTH
Practice Address - Street 2:WYOMING STATE HOSPITAL
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82931
Practice Address - Country:US
Practice Address - Phone:307-789-3464
Practice Address - Fax:307-789-7213
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000157041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily