Healthcare Provider Details

I. General information

NPI: 1700339363
Provider Name (Legal Business Name): KOREN WASHINGTON-COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 BRES AVE STE G
MONROE LA
71201-5869
US

IV. Provider business mailing address

215 BRES AVE STE G
MONROE LA
71201-5869
US

V. Phone/Fax

Practice location:
  • Phone: 318-509-8073
  • Fax: 318-703-5765
Mailing address:
  • Phone: 318-509-8073
  • Fax: 318-703-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: