Provider Demographics
NPI:1811561806
Name:COLER, MEDEA LYNN
Entity Type:Individual
Prefix:
First Name:MEDEA
Middle Name:LYNN
Last Name:COLER
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 1:1845 LEMONT DR
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1422
Mailing Address - Country:US
Mailing Address - Phone:330-518-3333
Mailing Address - Fax:
Practice Address - Street 1:1845 LEMONT DR
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1422
Practice Address - Country:US
Practice Address - Phone:330-518-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1012Medicaid