Provider Demographics
NPI:1982841573
Name:COLEMAN, JOSHUA L (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:L
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3327 N EAGLE RD. STE 110 PMB 141
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646
Mailing Address - Country:US
Mailing Address - Phone:208-917-2713
Mailing Address - Fax:
Practice Address - Street 1:3085 E MAGIC VIEW DR STE 140
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3757
Practice Address - Country:US
Practice Address - Phone:208-433-9300
Practice Address - Fax:208-433-9854
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA741367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1982841573Medicaid