Provider Demographics
NPI:1396880555
Name:COATES, DOROTHY MARIE (LPN)
Entity type:Individual
Prefix:MISS
First Name:DOROTHY
Middle Name:MARIE
Last Name:COATES
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 1:875 SHIPLETT ROAD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701
Mailing Address - Country:US
Mailing Address - Phone:740-453-6481
Mailing Address - Fax:
Practice Address - Street 1:2202 OUTVILLE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:OH
Practice Address - Zip Code:43001
Practice Address - Country:US
Practice Address - Phone:740-924-9472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN085404164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2195468Medicaid
2195468Medicare UPIN