Provider Demographics
NPI:1942954763
Name:COFFEY, MELISSA LORNA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LORNA
Last Name:COFFEY
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 1:7420 CRANE PL
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4606
Mailing Address - Country:US
Mailing Address - Phone:202-487-0349
Mailing Address - Fax:
Practice Address - Street 1:1320 MISSISSIPPI AVE SE UNIT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4429
Practice Address - Country:US
Practice Address - Phone:202-524-8907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC3747P1801XOtherTECHNICIAN CARE ATTENDANT