Provider Demographics
NPI:1154848752
Name:COLEMAN, LATISHA A
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:A
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 1:4151 E 106TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-5308
Mailing Address - Country:US
Mailing Address - Phone:216-466-7586
Mailing Address - Fax:
Practice Address - Street 1:4151 EAST 106ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105
Practice Address - Country:US
Practice Address - Phone:216-466-7586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker