Provider Demographics
NPI:1275521395
Name:COLEMAN, JULIA R (CNM)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:R
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 N. 3RD ST.
Mailing Address - Street 2:STE. 4020
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1130
Mailing Address - Country:US
Mailing Address - Phone:602-323-3242
Mailing Address - Fax:602-323-3496
Practice Address - Street 1:1492 S. MILL AVE.
Practice Address - Street 2:STE. 312
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281
Practice Address - Country:US
Practice Address - Phone:480-921-1100
Practice Address - Fax:480-927-1092
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF0001501176B00000X
AZRN110116176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ802901Medicaid
AZS50515Medicare UPIN
AZ109341Medicare PIN
AZ802901Medicaid
M2N931Medicare ID - Type Unspecified