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Individual

ANGELA ANN COYNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
1605 E RIVERSIDE DRIVE, EAGLE, ID 83616-6237
(208) 939-6227
(208) 939-6442
Mailing address
1605 E RIVERSIDE DRIVE, EAGLE, ID 83616-6237
(208) 939-6227
(208) 939-6442

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-512
ID
363AS0400X
Surgical Physician Assistant
PA-512
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PA-512
LICENSE
ID
Enumeration date
08/23/2006
Last updated
11/03/2022
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