Healthcare Provider Details

I. General information

NPI: 1942792015
Provider Name (Legal Business Name): CHENELL LANIECE COLEMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NIAGARA ST
BUFFALO NY
14213-2116
US

IV. Provider business mailing address

3176 ABBOTT RD STE 500
ORCHARD PARK NY
14127-1069
US

V. Phone/Fax

Practice location:
  • Phone: 716-884-0700
  • Fax: 716-884-1758
Mailing address:
  • Phone: 716-822-2177
  • Fax: 716-822-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number808995
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: