Provider Demographics
NPI:1801900154
Name:COYNE, NANCY MAE (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MAE
Last Name:COYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 N ALAMO PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4356
Mailing Address - Country:US
Mailing Address - Phone:207-751-7109
Mailing Address - Fax:888-291-8288
Practice Address - Street 1:1531 N ALAMO PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4356
Practice Address - Country:US
Practice Address - Phone:207-751-7109
Practice Address - Fax:888-291-8288
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME74522084P0800X
AZ355482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME227520000Medicaid
ME227520000Medicaid
B86260Medicare UPIN