Provider Demographics
NPI:1740261759
Name:COLEMAN, SHAUNA MARLENE (FNP)
Entity type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:MARLENE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 RENAISSANCE PKWY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6688
Mailing Address - Country:US
Mailing Address - Phone:919-425-0002
Mailing Address - Fax:
Practice Address - Street 1:8210 RENAISSANCE PKWY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6688
Practice Address - Country:US
Practice Address - Phone:919-425-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592501Medicare UPIN