Provider Demographics
NPI:1922416478
Name:COFFY, CHANTAL MARTINA (RN)
Entity Type:Individual
Prefix:
First Name:CHANTAL
Middle Name:MARTINA
Last Name:COFFY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MICHAEL ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854
Mailing Address - Country:US
Mailing Address - Phone:203-854-6995
Mailing Address - Fax:203-433-5443
Practice Address - Street 1:9 MICHAEL ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854
Practice Address - Country:US
Practice Address - Phone:203-854-6995
Practice Address - Fax:203-433-5443
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE51445163W00000X
NY657056163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse