Provider Demographics
NPI:1376252148
Name:COLEMAN, DONNA RENEE (PRSS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:RENEE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:RAVENSWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26164-1403
Mailing Address - Country:US
Mailing Address - Phone:304-761-0611
Mailing Address - Fax:
Practice Address - Street 1:802 OAK ST
Practice Address - Street 2:
Practice Address - City:KENOVA
Practice Address - State:WV
Practice Address - Zip Code:25530-1519
Practice Address - Country:US
Practice Address - Phone:304-761-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21-9144175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist