Provider Demographics
NPI:1770878126
Name:COYLE, JANE MARIE (LPN IV)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:COYLE
Suffix:
Gender:F
Credentials:LPN IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 DARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-3760
Mailing Address - Country:US
Mailing Address - Phone:216-496-1016
Mailing Address - Fax:
Practice Address - Street 1:12901 DARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3760
Practice Address - Country:US
Practice Address - Phone:216-496-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.130554-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse