Provider Demographics
NPI:1477953545
Name:KELOW-COLEMAN, CHARLENE X
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:KELOW-COLEMAN
Suffix:X
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 1:1722 W NORTH BEND RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-2460
Mailing Address - Country:US
Mailing Address - Phone:513-485-0456
Mailing Address - Fax:
Practice Address - Street 1:1722 W NORTH BEND RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2460
Practice Address - Country:US
Practice Address - Phone:513-485-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant