Provider Demographics
NPI:1821388497
Name:COLEMAN, MELYSSA
Entity Type:Individual
Prefix:
First Name:MELYSSA
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 1:1720 S BELLAIRE ST
Mailing Address - Street 2:STE 325
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4304
Mailing Address - Country:US
Mailing Address - Phone:866-801-9492
Mailing Address - Fax:
Practice Address - Street 1:1720 S BELLAIRE ST
Practice Address - Street 2:STE 325
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4304
Practice Address - Country:US
Practice Address - Phone:866-801-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO719693376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide