Provider Demographics
NPI:1801854823
Name:COLEMAN, LANIECE A (CNMW)
Entity Type:Individual
Prefix:
First Name:LANIECE
Middle Name:A
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CNMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4404
Mailing Address - Country:US
Mailing Address - Phone:215-955-6776
Mailing Address - Fax:215-955-4020
Practice Address - Street 1:833 CHESTNUT ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4404
Practice Address - Country:US
Practice Address - Phone:215-955-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010014367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001915437Medicaid
PA062230Medicare ID - Type Unspecified