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NPI Code Detail

MEDICARE: JENNIFER COLEMAN LPN

MEDICARE: JENNIFER COLEMAN LPN
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
1164W00000XLicensed Practical NurseP31748SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P3178OTHERSCNURSE

General Provider Information

NPI Number : 1386120491
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER COLEMAN LPN
Provider Business Mailing Address
First Line : 104 GEORGE BISHOP PKWY
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29579-7335
Country : US
Telephone Number : 843-903-6212
Fax Number :
Provider Business Practice Location Address
First Line : 104 GEORGE BISHOP PKWY
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29579-7335
Country : US
Telephone Number : 843-903-6212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2018
Last Update Date : 07/12/2018

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