Provider Demographics
NPI:1083188965
Name:COALMER, LORRAINE (PHD, APRN-CNS-BC, CC)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:
Last Name:COALMER
Suffix:
Gender:F
Credentials:PHD, APRN-CNS-BC, CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1556
Mailing Address - Country:US
Mailing Address - Phone:330-480-2866
Mailing Address - Fax:330-480-4084
Practice Address - Street 1:452 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1556
Practice Address - Country:US
Practice Address - Phone:330-480-2866
Practice Address - Fax:330-480-4084
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNS.09308207RE0101X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0357364Medicaid