Provider Demographics
NPI:1114222528
Name:COLEMAN, MARILYN ANNA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:ANNA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-2106
Mailing Address - Country:US
Mailing Address - Phone:440-240-8882
Mailing Address - Fax:
Practice Address - Street 1:308 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-2106
Practice Address - Country:US
Practice Address - Phone:440-240-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 130224 M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse