Provider Demographics
NPI:1740863240
Name:COLEMAN, ELISHIA (RWP)
Entity type:Individual
Prefix:
First Name:ELISHIA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:RWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10474 E ALDER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-2617
Mailing Address - Country:US
Mailing Address - Phone:805-459-5538
Mailing Address - Fax:
Practice Address - Street 1:10474 E ALDER CREEK RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-2617
Practice Address - Country:US
Practice Address - Phone:805-459-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
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