Provider Demographics
NPI:1356427348
Name:COFFIN, MARY ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:COFFIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:PIACENTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9451 HURON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-5426
Mailing Address - Country:US
Mailing Address - Phone:303-650-4042
Mailing Address - Fax:303-650-4046
Practice Address - Street 1:9451 HURON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-5426
Practice Address - Country:US
Practice Address - Phone:303-650-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2405363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69185735Medicaid
CO1356427348Medicaid