Provider Demographics
NPI:1720432487
Name:SHEARS COATES, LAURA NIKKI
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:NIKKI
Last Name:SHEARS COATES
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 1:1023 PHILLIP DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4052
Mailing Address - Country:US
Mailing Address - Phone:410-689-5057
Mailing Address - Fax:
Practice Address - Street 1:2901 DRUID PARK DR STE A202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-8131
Practice Address - Country:US
Practice Address - Phone:410-689-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker