Basic Information
| Provider Information | |||||||||
| NPI: | 1700999448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COELHO | ||||||||
| FirstName: | NANETTE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4320 SUMMERFIELD DR | ||||||||
| Address2: | |||||||||
| City: | PINEY FLATS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376864560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
| FaxNumber: | 4239793530 | ||||||||
| Practice Location | |||||||||
| Address1: | BUILDING 8 | ||||||||
| Address2: | VAMC EYE CLINIC | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
| FaxNumber: | 4239793530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 152W00000X | 152W00000X | TN | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 152W00000X | FL | N | Eye and Vision Services Providers | Optometrist |
No ID Information.