Provider Demographics
NPI:1144584491
Name:COLEMAN, SUSAN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
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 1:109 RALSTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-2649
Mailing Address - Country:US
Mailing Address - Phone:781-340-1567
Mailing Address - Fax:866-258-3144
Practice Address - Street 1:109 RALSTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2649
Practice Address - Country:US
Practice Address - Phone:781-340-1567
Practice Address - Fax:866-258-3144
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN191227163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse