Healthcare Provider Details

I. General information

NPI: 1881887602
Provider Name (Legal Business Name): COEHLO & COEHLO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 SW CROWELL WAY STE 100
BEND OR
97702-1178
US

IV. Provider business mailing address

132 SW CROWELL WAY STE 100
BEND OR
97702-1178
US

V. Phone/Fax

Practice location:
  • Phone: 541-385-5515
  • Fax: 541-385-5578
Mailing address:
  • Phone: 541-385-5515
  • Fax: 541-385-5578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number090007430N1
License Number StateOR

VIII. Authorized Official

Name: THOMAS E COEHLO
Title or Position: OWNER
Credential: FNP-C
Phone: 541-385-5515