Individual
CAROL S. COFFEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
504 S VINE ST, ADVANCE, MO 63730-8060
(573) 722-6111
(573) 722-6555
Mailing address
PO BOX 435, ADVANCE, MO 63730-0435
(573) 722-6111
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
2001031601
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266135003
—
MO
Enumeration date
07/29/2019
Last updated
07/29/2019
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