1053723973 NPI number — MRS. CELESTE NACOLE COFFMAN ALC

Table of content: MRS. CELESTE NACOLE COFFMAN ALC (NPI 1053723973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053723973 NPI number — MRS. CELESTE NACOLE COFFMAN ALC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COFFMAN
Provider First Name:
CELESTE
Provider Middle Name:
NACOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ALC
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:
1053723973
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 E MOBILE ST
Provider Second Line Business Mailing Address:
SUITE 316
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35630-4782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-206-2032
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 E MOBILE ST
Provider Second Line Business Practice Location Address:
SUITE 316
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35630-4782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-206-2032
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2014

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: 101Y00000X , with the licence number:  C2195A , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com