Provider Demographics
NPI:1669703161
Name:COFFEY, WILLIAM (RN)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:COFFEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:COFFEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2391 NORTHEAST LOOP 410
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4282
Mailing Address - Country:US
Mailing Address - Phone:210-222-0152
Mailing Address - Fax:
Practice Address - Street 1:2391 NORTHEAST LOOP 410 SUITE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4282
Practice Address - Country:US
Practice Address - Phone:210-222-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521683163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse