Provider Demographics
NPI:1336396886
Name:COADY, LUCILLE ANNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:ANNE
Last Name:COADY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LUCILLE
Other - Middle Name:ANNE
Other - Last Name:KROL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:601 ELMWOOD AVE BOX 668,
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-341-6732
Mailing Address - Fax:585-341-8381
Practice Address - Street 1:909 CULVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7141
Practice Address - Country:US
Practice Address - Phone:716-688-0500
Practice Address - Fax:716-688-5565
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY360506363LX0001X
NYF001258-1367A00000X
NYF360506-1363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife