Basic Information
| Provider Information | |||||||||
| NPI: | 1417457243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COFIE | ||||||||
| FirstName: | ELSIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 OAK CREEK LN APT B | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760227912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142005042 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1314 LAKE ST | ||||||||
| Address2: | 101 | ||||||||
| City: | FORTH WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178100660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2018 | ||||||||
| LastUpdateDate: | 02/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 863630 | TX | Y | Nursing Service Providers | Registered Nurse |
No ID Information.