Provider Demographics
NPI:1659830628
Name:COAXUM, BRIA
Entity Type:Individual
Prefix:
First Name:BRIA
Middle Name:
Last Name:COAXUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BAINBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1802
Mailing Address - Country:US
Mailing Address - Phone:718-594-4213
Mailing Address - Fax:
Practice Address - Street 1:150 BAINBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1802
Practice Address - Country:US
Practice Address - Phone:718-594-4213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula