Provider Demographics
NPI:1730665746
Name:COLEMAN, TAEKWONDA
Entity Type:Individual
Prefix:
First Name:TAEKWONDA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24411 MAVEC AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2415
Mailing Address - Country:US
Mailing Address - Phone:216-358-5074
Mailing Address - Fax:
Practice Address - Street 1:24411 MAVEC AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2415
Practice Address - Country:US
Practice Address - Phone:216-358-5074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401332151211376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401332151211OtherOHIO STATE TESTED NURSE AIDE