Provider Demographics
NPI:1902904808
Name:COFFEY, MONICA C (FNP, CWNC)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:C
Last Name:COFFEY
Suffix:
Gender:F
Credentials:FNP, CWNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WATER ST
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-5231
Mailing Address - Country:US
Mailing Address - Phone:207-374-3935
Mailing Address - Fax:207-374-3970
Practice Address - Street 1:57 WATER ST
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-5231
Practice Address - Country:US
Practice Address - Phone:207-374-3935
Practice Address - Fax:207-374-3970
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81347363LF0000X
ME028337367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1902904808Medicaid
MEMM216009OtherMED B
ME201020OtherCOASTAL EYE SURGERY CENTER
MEMM216006Other(FOR 200051)
MEMM216006Other(FOR 200051)
MEME067202Medicare PIN
MEME067203Medicare PIN