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NPI Code Detail

MEDICARE: SANDRA LYNN COLEMAN FNP-C

MEDICARE: SANDRA LYNN COLEMAN FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WG0000XGeneral Practice Registered Nurse06192LA

General Provider Information

NPI Number : 1124334412
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA LYNN COLEMAN FNP-C
Provider Business Mailing Address
First Line : 5152 NAFF AVE
Second Line :
City : BASTROP
State : LA
Zip : 71220-8245
Country : US
Telephone Number : 318-281-6460
Fax Number :
Provider Business Practice Location Address
First Line : 2101 TOWER DR
Second Line :
City : MONROE
State : LA
Zip : 71201-5045
Country : US
Telephone Number : 318-387-4878
Fax Number : 318-387-1317
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2010
Last Update Date : 08/24/2010

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Directions to “ SANDRA LYNN COLEMAN FNP-C” Practice Location

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