Healthcare Provider Details

I. General information

NPI: 1023733011
Provider Name (Legal Business Name): ASHLEY COLEMAN RN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4841 N 60TH LN
PHOENIX AZ
85033-1709
US

IV. Provider business mailing address

10720 W INDIAN SCHOOL RD STE 19
PHOENIX AZ
85037-5799
US

V. Phone/Fax

Practice location:
  • Phone: 602-919-9460
  • Fax:
Mailing address:
  • Phone: 602-919-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number343180
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number343180
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number280722
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: