Provider Demographics
NPI:1497801401
Name:COLEMAN, JOANN (CRNP)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64474
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4474
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 N BROADWAY
Practice Address - Street 2:SUITE 1440
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1146
Practice Address - Country:US
Practice Address - Phone:410-955-5718
Practice Address - Fax:410-502-1414
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR053426363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care