Provider Demographics
NPI:1497883482
Name:COLEMAN, VIVIAN LEIGH (RN)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:LEIGH
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 BRINDLEY DR
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4705
Mailing Address - Country:US
Mailing Address - Phone:931-363-5438
Mailing Address - Fax:931-363-3564
Practice Address - Street 1:1002 BRINDLEY DR
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4705
Practice Address - Country:US
Practice Address - Phone:931-363-5438
Practice Address - Fax:931-363-3564
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000097570163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent