Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 1035054 | TX |
NPI | 1003219700 |
---|---|
Provider Name | Mrs. Sandra Marie Coleman |
First Address | Midlothian, TX 76065-8805 |
Second Address | Dallas, TX 75224-4003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2014 |
Last Update Date | 08/10/2021 |