Provider Demographics
NPI:1538338140
Name:COATES, NICOLE LYNN (NP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:COATES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:WOODROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:77 W BARNEY ST
Mailing Address - Street 2:
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642-1040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2924 COUNTY ROUTE 17
Practice Address - Street 2:
Practice Address - City:DEKALB JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:13630
Practice Address - Country:US
Practice Address - Phone:315-347-3830
Practice Address - Fax:315-347-3840
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily