Individual
ETIENNA COLEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3621 LOUISIANA AVE, SAINT LOUIS, MO 63118-3509
(314) 550-2990
Mailing address
3621 LOUISIANA AVE, SAINT LOUIS, MO 63118-3509
(314) 550-2990
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
81-3262557
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81326557
—
MO
Enumeration date
10/21/2016
Last updated
12/30/2016
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