Provider Demographics
NPI:1902939549
Name:COLEMAN, PATRICIA ANN (NURSE LPN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:NURSE LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:LUNA PIER
Mailing Address - State:MI
Mailing Address - Zip Code:48157-0131
Mailing Address - Country:US
Mailing Address - Phone:734-848-8128
Mailing Address - Fax:
Practice Address - Street 1:4334 S 6TH STREET
Practice Address - Street 2:
Practice Address - City:LUNA PIER
Practice Address - State:MI
Practice Address - Zip Code:48157-0131
Practice Address - Country:US
Practice Address - Phone:734-848-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN067292164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse