MEDICARE: TERESA MARYA COYNE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	NP06998	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00222386	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000374980	OTHER	OH	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457455149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA MARYA COYNE NP

Provider Business Mailing Address
First Line	:	6401 W 54TH ST
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44129
Country	:	US
Telephone Number	:	440-842-6744
Fax Number	:

Provider Business Practice Location Address
First Line	:	23225 LORAIN
Second Line	:
City	:	N OLMSTEAD
State	:	OH
Zip	:	44070
Country	:	US
Telephone Number	:	440-779-6900
Fax Number	:	440-779-8091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/08/2007

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