Provider Demographics
NPI:1891433157
Name:REA COFFEEN, LAURA LOUISE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LOUISE
Last Name:REA COFFEEN
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 1:9680 W TROPICANA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8245
Mailing Address - Country:US
Mailing Address - Phone:702-955-8345
Mailing Address - Fax:
Practice Address - Street 1:9680 W TROPICANA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8245
Practice Address - Country:US
Practice Address - Phone:702-955-8345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker