Provider Demographics
NPI:1508234535
Name:COLEMAN, JEAN ELAINE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ELAINE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 BOLLING QUARTER RD
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-3843
Mailing Address - Country:US
Mailing Address - Phone:804-231-1839
Mailing Address - Fax:
Practice Address - Street 1:5530 BOLLING QUARTER RD
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-3843
Practice Address - Country:US
Practice Address - Phone:804-231-1839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001080418163W00000X
VA0024080418363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse