Healthcare Provider Details

I. General information

NPI: 1477168789
Provider Name (Legal Business Name): YALANDA COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 NOBLE RD
EAST CLEVELAND OH
44112-1725
US

IV. Provider business mailing address

1571 BUNTS RD
LAKEWOOD OH
44107-4514
US

V. Phone/Fax

Practice location:
  • Phone: 216-268-2400
  • Fax:
Mailing address:
  • Phone: 216-762-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP.N146082
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: