Healthcare Provider Details

I. General information

NPI: 1174874556
Provider Name (Legal Business Name): CHERYL LYNN COFFEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

IV. Provider business mailing address

ONE CHILREN'S PLAZA
DAYTON OH
45404
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3111
  • Fax: 937-641-5885
Mailing address:
  • Phone: 937-641-3111
  • Fax: 937-641-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number225877
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: