Healthcare Provider Details

I. General information

NPI: 1760922926
Provider Name (Legal Business Name): RASHANN COLEMAN RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 STATE HIGHWAY 121 APT 1023
LEWISVILLE TX
75056-4282
US

IV. Provider business mailing address

5500 STATE HIGHWAY 121 APT 1023
LEWISVILLE TX
75056-4282
US

V. Phone/Fax

Practice location:
  • Phone: 773-391-0549
  • Fax:
Mailing address:
  • Phone: 773-391-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number734150
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: