MEDICARE: DANA GENE COALSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0705X	Medical-Surgical Registered Nurse	RN300720	GA

General Provider Information

NPI Number	:	1124782743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA GENE COALSON RN

Provider Business Mailing Address
First Line	:	6111 DUNVEGAN DR APT 305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-6772
Country	:	US
Telephone Number	:	470-755-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	6111 DUNVEGAN DR APT 305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-6772
Country	:	US
Telephone Number	:	470-755-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2021
Last Update Date	:	10/29/2021

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