MEDICARE: MARQUITA CASSANDRA COLEMAN LPN

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	164W00000X	Licensed Practical Nurse	337037	NY

General Provider Information

NPI Number	:	1194422915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUITA CASSANDRA COLEMAN LPN

Provider Business Mailing Address
First Line	:	58 NISA LN
Second Line	:
City	:	GATES
State	:	NY
Zip	:	14606-4051
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 NISA LN
Second Line	:
City	:	GATES
State	:	NY
Zip	:	14606-4051
Country	:	US
Telephone Number	:	585-557-4637
Fax Number	:

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

Provider Enumeration Date	:	02/13/2023
Last Update Date	:	02/13/2023

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