Provider Demographics
NPI:1609155944
Name:COLEMAN, SHARON L (APRN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8840 COMMERCE PARK PL STE E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 N JIM DAY RD
Practice Address - Street 2:SUITE 107A
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-5200
Practice Address - Country:US
Practice Address - Phone:812-883-5501
Practice Address - Fax:812-883-5513
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3006964363LF0000X
IN71003641A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100263720Medicaid
IN201060950Medicaid
KY7100263720Medicaid
KYK080262Medicare PIN