Healthcare Provider Details

I. General information

NPI: 1598176794
Provider Name (Legal Business Name): JOANNE COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 WILLARD AVE SE
WARREN OH
44484-5061
US

IV. Provider business mailing address

2020 WILLARD AVE SE
WARREN OH
44484-5061
US

V. Phone/Fax

Practice location:
  • Phone: 330-675-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN 128881
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: