Provider Demographics
NPI:1912028606
Name:COEY, TAMMY (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:COEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:GLOUSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45732-1227
Mailing Address - Country:US
Mailing Address - Phone:740-767-2343
Mailing Address - Fax:
Practice Address - Street 1:47 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:GLOUSTER
Practice Address - State:OH
Practice Address - Zip Code:45732-1227
Practice Address - Country:US
Practice Address - Phone:740-767-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-097067164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2316336Medicaid
OH2316336Medicare ID - Type UnspecifiedI.P.LPN