Provider Demographics
NPI:1568425957
Name:COLEMAN, KATHLEEN RITA (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RITA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HIGH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7689
Mailing Address - Country:US
Mailing Address - Phone:207-795-5770
Mailing Address - Fax:207-795-5779
Practice Address - Street 1:12 HIGH ST STE 200
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7689
Practice Address - Country:US
Practice Address - Phone:207-795-5770
Practice Address - Fax:207-795-5779
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP811115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECONP2057Medicare UPIN
MENP205701Medicare UPIN
C66603Medicare UPIN