Provider Demographics
NPI:1407193824
Name:COLEMAN, GENENE MCDONALD (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:GENENE
Middle Name:MCDONALD
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2856 GLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7910
Mailing Address - Country:US
Mailing Address - Phone:504-391-0842
Mailing Address - Fax:
Practice Address - Street 1:1400 TECHE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-5843
Practice Address - Country:US
Practice Address - Phone:504-361-9800
Practice Address - Fax:504-368-9836
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO7109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0132708Medicaid