Healthcare Provider Details

I. General information

NPI: 1346892213
Provider Name (Legal Business Name): LISA COLEMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2344 RIVERSIDE DR
DANVILLE VA
24540-4212
US

IV. Provider business mailing address

574 MANGRUMS RD
DANVILLE VA
24541-8508
US

V. Phone/Fax

Practice location:
  • Phone: 540-769-3964
  • Fax:
Mailing address:
  • Phone: 434-228-9571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberF07190388
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0024178030
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024178030
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178030
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: