Healthcare Provider Details

I. General information

NPI: 1427067602
Provider Name (Legal Business Name): CHARLI MICHELLE COELHO EFDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14406 NE 20TH AVE
VANCOUVER WA
98686-1448
US

IV. Provider business mailing address

106 NW 146TH ST
VANCOUVER WA
98685-5754
US

V. Phone/Fax

Practice location:
  • Phone: 360-571-3139
  • Fax: 360-571-3149
Mailing address:
  • Phone: 360-546-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: