Basic Information
| Provider Information | |||||||||
| NPI: | 1275978736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | GLORIA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7225 E SOUTHGATE DR | ||||||||
| Address2: | SUITE D | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958232652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163941000 | ||||||||
| FaxNumber: | 9163941010 | ||||||||
| Practice Location | |||||||||
| Address1: | 7225 E SOUTHGATE DR | ||||||||
| Address2: | SUITE D | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958232652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163941000 | ||||||||
| FaxNumber: | 9163941010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2013 | ||||||||
| LastUpdateDate: | 05/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN 241922 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.