Provider Demographics
NPI:1417184458
Name:COLEMAN, VERONICA MICHELL
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:MICHELL
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 1:2611 KNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61101-4246
Mailing Address - Country:US
Mailing Address - Phone:815-289-3803
Mailing Address - Fax:
Practice Address - Street 1:2611 KNIGHT AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-4246
Practice Address - Country:US
Practice Address - Phone:815-289-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife