Healthcare Provider Details

I. General information

NPI: 1134687759
Provider Name (Legal Business Name): SUSIE M COLEMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 FOOTHILL BLVD STE 200
OAKLAND CA
94605-2426
US

IV. Provider business mailing address

6955 FOOTHILL BLVD STE 200
OAKLAND CA
94605-2426
US

V. Phone/Fax

Practice location:
  • Phone: 510-567-5726
  • Fax: 510-567-5735
Mailing address:
  • Phone: 510-567-5726
  • Fax: 510-567-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number455974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: