Provider Demographics
NPI:1134687759
Name:COLEMAN, SUSIE M (RN)
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:M
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 FOOTHILL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2426
Mailing Address - Country:US
Mailing Address - Phone:510-567-5726
Mailing Address - Fax:510-567-5735
Practice Address - Street 1:6955 FOOTHILL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2426
Practice Address - Country:US
Practice Address - Phone:510-567-5726
Practice Address - Fax:510-567-5735
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA455974163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory