Provider Demographics
NPI:1548587082
Name:COLEMAN, DANIEL VICTOR (LPN)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:VICTOR
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-1012
Mailing Address - Country:US
Mailing Address - Phone:937-981-0656
Mailing Address - Fax:
Practice Address - Street 1:806 N 4TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-1012
Practice Address - Country:US
Practice Address - Phone:937-981-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN037569164W00000X, 302R00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No372600000XNursing Service Related ProvidersAdult Companion