Provider Demographics
NPI:1497081772
Name:COLEMAN, SCHAWANDA ALLEN
Entity Type:Individual
Prefix:MRS
First Name:SCHAWANDA
Middle Name:ALLEN
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 1:2753 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-4657
Mailing Address - Country:US
Mailing Address - Phone:318-629-5391
Mailing Address - Fax:318-629-5392
Practice Address - Street 1:2753 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-4657
Practice Address - Country:US
Practice Address - Phone:318-629-5391
Practice Address - Fax:318-629-5392
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADHC 50513747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant