Healthcare Provider Details

I. General information

NPI: 1164257671
Provider Name (Legal Business Name): CRISTIAN COLEMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 N ROXBORO ST
DURHAM NC
27704-2702
US

IV. Provider business mailing address

142 CRYSTAL BAY RD
SEMORA NC
27343-9098
US

V. Phone/Fax

Practice location:
  • Phone: 919-470-8612
  • Fax:
Mailing address:
  • Phone: 919-698-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number145080
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: