Healthcare Provider Details

I. General information

NPI: 1821299967
Provider Name (Legal Business Name): CYNTHIA ANN COLEMAN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8060 KNUE RD SUITE 110
INDIANAPOLIS IN
46250-1976
US

IV. Provider business mailing address

4745 TINCHER RD
INDIANAPOLIS IN
46221-3779
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-7435
  • Fax: 317-842-7674
Mailing address:
  • Phone: 317-856-9874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number27055021A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: