Individual
STACEY L COLEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
313 CAMBORNE DR, ENGLEWOOD, OH 45322-1211
(937) 830-7908
Mailing address
313 CAMBORNE DR, ENGLEWOOD, OH 45322-1211
(937) 830-7908
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0412382
—
OH
Enumeration date
12/23/2020
Last updated
12/23/2020
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