Provider Demographics
NPI:1164128815
Name:COLEMAN, STEPHANIE JANE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JANE
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 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1100
Mailing Address - Country:US
Mailing Address - Phone:765-935-5331
Mailing Address - Fax:
Practice Address - Street 1:1473 E STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-8374
Practice Address - Country:US
Practice Address - Phone:765-825-0511
Practice Address - Fax:765-827-1247
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013299A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71013299AOtherINDIANA APRN LICENSE