Provider Demographics
NPI:1881016525
Name:COLEMAN, SCOTT ALAN (RN, MS, AE-C)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALAN
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:RN, MS, AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 MILITARY TPKE
Mailing Address - Street 2:
Mailing Address - City:WEST CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12992-3918
Mailing Address - Country:US
Mailing Address - Phone:518-563-3382
Mailing Address - Fax:
Practice Address - Street 1:2636 MILITARY TPKE
Practice Address - Street 2:
Practice Address - City:WEST CHAZY
Practice Address - State:NY
Practice Address - Zip Code:12992-3918
Practice Address - Country:US
Practice Address - Phone:518-563-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY467230-1163W00000X, 163WP0200X
NY467230163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient