Provider Demographics
NPI:1245417872
Name:COLEMAN, KATHRYN PAULINE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PAULINE
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 1:2155 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23521-3017
Mailing Address - Country:US
Mailing Address - Phone:757-462-7056
Mailing Address - Fax:757-462-7005
Practice Address - Street 1:2155 11TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521-3017
Practice Address - Country:US
Practice Address - Phone:757-462-7056
Practice Address - Fax:757-462-7005
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman