Individual
DEREK COLEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
503 S 101ST EAST AVE, TULSA, OK 74128-2637
(539) 664-4462
Mailing address
503 S 101ST EAST AVE, TULSA, OK 74128-2637
(539) 664-4462
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0043900
OK
Other
Enumeration date
07/14/2014
Last updated
07/14/2014
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