Healthcare Provider Details

I. General information

NPI: 1356492466
Provider Name (Legal Business Name): DOLORES L. COLEMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 MITCHELLVILLE RD SUITE 102
BOWIE MD
20716-3163
US

IV. Provider business mailing address

1111 BENFIELD BLVD SUITE 200
MILLERSVILLE MD
21108-3002
US

V. Phone/Fax

Practice location:
  • Phone: 410-741-9000
  • Fax: 410-741-0865
Mailing address:
  • Phone: 410-729-5100
  • Fax: 410-379-3591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR171311
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP-00992
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: