MEDICARE: DEBRA COYNE CRNP

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	1-048429	AL

General Provider Information

NPI Number	:	1578992574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA COYNE CRNP

Provider Business Mailing Address
First Line	:	1720 2ND AVE S
Second Line	:	FOT 930B
City	:	BIRMINGHAM
State	:	AL
Zip	:	35294-0004
Country	:	US
Telephone Number	:	205-975-4667
Fax Number	:	205-934-8720

Provider Business Practice Location Address
First Line	:	1720 2ND AVE S
Second Line	:	FOT 930B
City	:	BIRMINGHAM
State	:	AL
Zip	:	35294-0004
Country	:	US
Telephone Number	:	205-975-4667
Fax Number	:	205-934-8720

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

Provider Enumeration Date	:	11/11/2013
Last Update Date	:	11/11/2013

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