Provider Demographics
NPI:1023733011
Name:COLEMAN, ASHLEY (RN, CLC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10720 W INDIAN SCHOOL RD STE 19
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5799
Mailing Address - Country:US
Mailing Address - Phone:602-919-9460
Mailing Address - Fax:
Practice Address - Street 1:4841 N 60TH LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-1709
Practice Address - Country:US
Practice Address - Phone:602-919-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ343180163WL0100X, 174N00000X
AZ280722163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174N00000XOther Service ProvidersLactation Consultant, Non-RN