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General NPI Number Information
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NPI Number | 1073815957
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Entity Type | Individual
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Provider Name | PHYLLIS PATRICIA COCONIS NP
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Gender | Female
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Dates
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Enumeration Date | 11/25/2010
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Last Update Date | 01/01/2024
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Provider Practice Location Address
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Address Line | 2554 LEWISVILLE-CLEMMONS RD STE 109
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City | CLEMMONS
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State | NC
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Zip | 27012-8749
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Country | US
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Telephone | 704-766-1000
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Fax | 704-766-1002
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Provider Business Mailing Address
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Address Line | 610 BALFOUR RD
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City | WINSTON SALEM
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State | NC
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Zip | 27104-3061
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Country | US
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Telephone | 336-408-1409
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 171157
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License Number State | NC
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