Healthcare Provider Details

I. General information

NPI: 1306351630
Provider Name (Legal Business Name): MS. MOLLY JOANNA COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MOLLY JOANNA PATTERSON

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 CARDINAL LANE
GALLOPIS FERRY WV
25515
US

IV. Provider business mailing address

PO BOX 12 63 CARDINAL LANE
GALLOPIS FERRY WV
25515
US

V. Phone/Fax

Practice location:
  • Phone: 304-356-4562
  • Fax: 304-558-4563
Mailing address:
  • Phone: 304-356-4562
  • Fax: 304-558-4563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: