Provider Demographics
NPI:1437656576
Name:COLEMAN, ALEXANDRA (LPN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:16 CHATHAM DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1402
Mailing Address - Country:US
Mailing Address - Phone:631-456-1311
Mailing Address - Fax:
Practice Address - Street 1:16 CHATHAM DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1402
Practice Address - Country:US
Practice Address - Phone:631-456-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323522164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse