Provider Demographics
NPI:1881241347
Name:COFFIE, PERPETUAL (RN)
Entity type:Individual
Prefix:
First Name:PERPETUAL
Middle Name:
Last Name:COFFIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 MATTHEWS AVE # 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3611
Mailing Address - Country:US
Mailing Address - Phone:610-577-6835
Mailing Address - Fax:
Practice Address - Street 1:900 INTERVALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-4240
Practice Address - Country:US
Practice Address - Phone:718-732-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY423843163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse