Provider Demographics
NPI:1427063221
Name:COE, CHERIE
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:COE
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 1:34 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1239
Mailing Address - Country:US
Mailing Address - Phone:518-792-5403
Mailing Address - Fax:518-792-5403
Practice Address - Street 1:IRONGATE FAMILY PRACTICE ASSOCIATES
Practice Address - Street 2:3 IRONGATE CENTER
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-793-4409
Practice Address - Fax:518-793-5886
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334110363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ04211Medicare UPIN
NYRA0459Medicare ID - Type Unspecified