Provider Demographics
NPI:1700389509
Name:COLEMAN, JOHNITA R (STNA)
Entity Type:Individual
Prefix:MS
First Name:JOHNITA
Middle Name:R
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 E 13TH ST # 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-7408
Mailing Address - Country:US
Mailing Address - Phone:513-348-2198
Mailing Address - Fax:
Practice Address - Street 1:528 E 13TH ST # 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-7408
Practice Address - Country:US
Practice Address - Phone:513-348-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health