Basic Information
Provider Information
NPI: 1447443221
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COLEMAN
FirstName: JOCELYN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4815 LIBERTY AVE
Address2: STE GR70
City: PITTSBURGH
State: PA
PostalCode: 152242156
CountryCode: US
TelephoneNumber: 4125784484
FaxNumber: 4126056538
Practice Location
Address1: 4815 LIBERTY AVE
Address2: STE GR70
City: PITTSBURGH
State: PA
PostalCode: 152242156
CountryCode: US
TelephoneNumber: 4125784484
FaxNumber: 4126056538
Other Information
ProviderEnumerationDate: 08/24/2007
LastUpdateDate: 08/24/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XSP007243PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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