Provider Demographics
NPI:1699853762
Name:COFFMAN, ANNELLA MAE (ARNP)
Entity Type:Individual
Prefix:
First Name:ANNELLA
Middle Name:MAE
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:ARNP
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 1334
Mailing Address - Street 2:
Mailing Address - City:HOODSPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98548-1334
Mailing Address - Country:US
Mailing Address - Phone:360-877-6176
Mailing Address - Fax:
Practice Address - Street 1:2505 OLYMPIC HWY N
Practice Address - Street 2:SUITE 400
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2974
Practice Address - Country:US
Practice Address - Phone:360-426-2933
Practice Address - Fax:360-426-1409
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006691363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9641069Medicaid