Healthcare Provider Details

I. General information

NPI: 1588973937
Provider Name (Legal Business Name): GLORIA JUNE COATS RN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 MITCHELL ROAD SUITE H
CERES CA
95307
US

IV. Provider business mailing address

3641 MITCHELL ROAD SUITE H
CERES CA
95307
US

V. Phone/Fax

Practice location:
  • Phone: 209-531-0154
  • Fax: 209-531-0176
Mailing address:
  • Phone: 209-531-0154
  • Fax: 209-531-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: