1053424150 NPI number — JULIA F COENEN NP

Table of content: JULIA F COENEN NP (NPI 1053424150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053424150 NPI number — JULIA F COENEN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COENEN
Provider First Name:
JULIA
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053424150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 E HARRIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48813-1629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-543-1050
Provider Business Mailing Address Fax Number:
517-541-5870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 LANSING ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48813-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-543-5110
Provider Business Practice Location Address Fax Number:
517-543-9776
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  4704199741 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 481762711 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com