Provider Demographics
NPI:1558179341
Name:COATNEY, ULISSA N
Entity type:Individual
Prefix:MRS
First Name:ULISSA
Middle Name:N
Last Name:COATNEY
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 1:114 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-3321
Mailing Address - Country:US
Mailing Address - Phone:937-529-9205
Mailing Address - Fax:
Practice Address - Street 1:114 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-3321
Practice Address - Country:US
Practice Address - Phone:937-529-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHJGQ5359343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)