Basic Information
| Provider Information | |||||||||
| NPI: | 1689771339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COLEMAN | ||||||||
| OtherFirstName: | JANET | ||||||||
| OtherMiddleName: | LEWIS | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | R.N. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 249 BILLINGSLEY RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282111003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043365386 | ||||||||
| FaxNumber: | 7043310859 | ||||||||
| Practice Location | |||||||||
| Address1: | 249 BILLINGSLEY RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282111003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043365386 | ||||||||
| FaxNumber: | 7043310859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | 073934 | NC | Y | Nursing Service Providers | Registered Nurse | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 01180 | 01 | NC | HEALTH DEPARTMENT | OTHER |