MEDICARE: DEBBRA COLEMAN

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
1	163W00000X	Registered Nurse	186415	OH

General Provider Information

NPI Number	:	1447795653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBRA COLEMAN

Provider Business Mailing Address
First Line	:	2636 COLLINS RD
Second Line	:
City	:	COLLINS
State	:	OH
Zip	:	44826-9701
Country	:	US
Telephone Number	:	567-424-6499
Fax Number	:

Provider Business Practice Location Address
First Line	:	2636 COLLINS RD
Second Line	:
City	:	COLLINS
State	:	OH
Zip	:	44826-9701
Country	:	US
Telephone Number	:	567-424-6499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2016
Last Update Date	:	12/23/2016

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Directions to “ DEBBRA COLEMAN ” Practice Location

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