Basic Information
| Provider Information | |||||||||
| NPI: | 1841890076 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAPASSO | ||||||||
| FirstName: | COYOTE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEW CARLISLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453441835 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 106 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEW CARLISLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453441835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376671122 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2020 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | APRN.CNP.025985 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | APRN.CNP.025985 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.