Provider Demographics
NPI:1811368392
Name:COLEY, LASONDRA (CRNP)
Entity Type:Individual
Prefix:
First Name:LASONDRA
Middle Name:
Last Name:COLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 FAIRFAX PARK
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2805
Mailing Address - Country:US
Mailing Address - Phone:205-343-7300
Mailing Address - Fax:205-722-5335
Practice Address - Street 1:931 FAIRFAX PARK
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2805
Practice Address - Country:US
Practice Address - Phone:205-343-7300
Practice Address - Fax:205-722-5335
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1116620363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology