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General NPI Number Information
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NPI Number | 1811773013
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Entity Type | Individual
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Provider Name | DEIDRE MARIE COYNE FNP
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Gender | Female
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 1 BOSTON MEDICAL CTR PL STE 1
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City | BOSTON
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State | MA
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Zip | 02118-2999
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Country | US
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Telephone | 617-765-7926
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Fax |
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Provider Business Mailing Address
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Address Line | 310 BAHAMA DR APT C
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City | NORWOOD
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State | MA
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Zip | 02062-3831
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Country | US
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Telephone | 508-215-7345
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN2310493
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License Number State | MA
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