Provider Demographics
NPI:1699503847
Name:COY, ROBERT CHARLES II (LPN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:COY
Suffix:II
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22148 E VIA DEL VERDE
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-8143
Mailing Address - Country:US
Mailing Address - Phone:480-375-0216
Mailing Address - Fax:480-987-3815
Practice Address - Street 1:20435 S OLD ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9676
Practice Address - Country:US
Practice Address - Phone:480-987-5940
Practice Address - Fax:480-987-3815
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPO47372164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse