Provider Demographics
NPI:1306111471
Name:COPPIN, LESIA ANN-MARIE
Entity type:Individual
Prefix:
First Name:LESIA
Middle Name:ANN-MARIE
Last Name:COPPIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 KNAPP LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2204
Mailing Address - Country:US
Mailing Address - Phone:718-938-2809
Mailing Address - Fax:
Practice Address - Street 1:11 KNAPP LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2204
Practice Address - Country:US
Practice Address - Phone:718-938-2809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304512164W00000X
NY304512-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse