Individual
ANGELA COLEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2317 KIBBY RD, JACKSON, MI 49203-3835
(517) 489-8738
Mailing address
2317 KIBBY RD, JACKSON, MI 49203-3835
(517) 489-8738
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000
—
MI
Enumeration date
07/12/2018
Last updated
07/12/2018
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