Healthcare Provider Details

I. General information

NPI: 1437028438
Provider Name (Legal Business Name): GLORIA DENISE COYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD
SALEM VA
24153-6404
US

IV. Provider business mailing address

171 TODD LN
MADISON HEIGHTS VA
24572-5991
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax: 540-224-1906
Mailing address:
  • Phone: 540-982-2463
  • Fax: 540-224-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number0001289721
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: