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NPI Code Detail

MEDICARE: GLORIA DENISE COLES CHW

MEDICARE: GLORIA DENISE COLES CHW
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
1172V00000XCommunity Health WorkerMN

General Provider Information

NPI Number : 1174170435
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLORIA DENISE COLES CHW
Provider Business Mailing Address
First Line : 314 HENNEPIN AVE APT 713
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55401-1919
Country : US
Telephone Number : 612-695-8354
Fax Number :
Provider Business Practice Location Address
First Line : 3333 N 4TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55412-2615
Country : US
Telephone Number : 612-695-8354
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2019
Last Update Date : 08/21/2019

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Directions to “ GLORIA DENISE COLES CHW” Practice Location

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