Provider Demographics
NPI:1093418253
Name:COLEMAN, GLORIA JEAN
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23633
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-0633
Mailing Address - Country:US
Mailing Address - Phone:440-570-2591
Mailing Address - Fax:
Practice Address - Street 1:3557 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2609
Practice Address - Country:US
Practice Address - Phone:440-570-2591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant