MEDICARE: MS. LEE ANN COLEMAN APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	185734-4405	UT

General Provider Information

NPI Number	:	1689638850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEE ANN COLEMAN APRN

Provider Business Mailing Address
First Line	:	1348 S 1100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2421
Country	:	US
Telephone Number	:	801-467-3031
Fax Number	:	801-467-3032

Provider Business Practice Location Address
First Line	:	1348 S 1100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2421
Country	:	US
Telephone Number	:	801-467-3031
Fax Number	:	801-467-3032

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	07/08/2007

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