Healthcare Provider Details

I. General information

NPI: 1760310056
Provider Name (Legal Business Name): DANIELLE COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E 54TH ST STE 141
INDIANAPOLIS IN
46220-3581
US

IV. Provider business mailing address

1111 E 54TH ST STE 141
INDIANAPOLIS IN
46220-3581
US

V. Phone/Fax

Practice location:
  • Phone: 317-910-1730
  • Fax:
Mailing address:
  • Phone: 317-910-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number24-018275
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: