Provider Demographics
NPI:1952914194
Name:COFFMAN, CHARLOTTE ANN
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ANN
Last Name:COFFMAN
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 1:42 ASHLEY PL
Mailing Address - Street 2:LOT 2
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601
Mailing Address - Country:US
Mailing Address - Phone:304-678-8708
Mailing Address - Fax:
Practice Address - Street 1:42 ASHLEY PL
Practice Address - Street 2:LOT 2
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601
Practice Address - Country:US
Practice Address - Phone:304-678-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant