MEDICARE: MARY S COISH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	F1208	SC

General Provider Information

NPI Number	:	1447297395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY S COISH

Provider Business Mailing Address
First Line	:	403 STONEY LANDING RD
Second Line	:
City	:	MONCKS CORNER
State	:	SC
Zip	:	29461-3967
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 STONEY LANDING RD
Second Line	:
City	:	MONCKS CORNER
State	:	SC
Zip	:	29461-3967
Country	:	US
Telephone Number	:	843-761-8282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/08/2007

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