MEDICARE: NICOLE LYNN COATES 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	363LF0000X	Family Nurse Practitioner	341844	NY

General Provider Information

NPI Number	:	1538338140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LYNN COATES NP

Provider Business Mailing Address
First Line	:	77 W BARNEY ST
Second Line	:
City	:	GOUVERNEUR
State	:	NY
Zip	:	13642-1040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2924 COUNTY ROUTE 17
Second Line	:
City	:	DEKALB JUNCTION
State	:	NY
Zip	:	13630
Country	:	US
Telephone Number	:	315-347-3830
Fax Number	:	315-347-3840

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

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	07/10/2024

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