Basic Information
| Provider Information | |||||||||
| NPI: | 1003276197 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COFFIA | ||||||||
| FirstName: | MICHAELA | ||||||||
| MiddleName: | |||||||||
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| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BAH | ||||||||
| OtherFirstName: | MICHAELA | ||||||||
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| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6227 FRANKFORT HWY | ||||||||
| Address2: | |||||||||
| City: | BENZONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496168632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318829661 | ||||||||
| FaxNumber: | 2318829616 | ||||||||
| Practice Location | |||||||||
| Address1: | 826 FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496359003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2313525285 | ||||||||
| FaxNumber: | 2313526384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2016 | ||||||||
| LastUpdateDate: | 09/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704269943 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.