Provider Demographics
NPI:1205471083
Name:COLEMAN, SYLVIA (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:
Other - Last Name:PRYOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGPCNP-BC
Mailing Address - Street 1:2422 183RD ST APT 208
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 W KINZIE ST STE 17
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-6393
Practice Address - Country:US
Practice Address - Phone:312-776-2446
Practice Address - Fax:312-776-2459
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020394363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209020394OtherADULT GERONTOLOGY PRIMARY CARE NURSE PRACTITIONER