Individual
MRS. CYNTHIA ROSEMARY ETHERIDGE-COLEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
87 HAYES ST, STAFFORD, VA 22556-8603
(518) 209-3801
Mailing address
87 HAYES ST, STAFFORD, VA 22556-8603
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1255344
VA
163WW0000X
Wound Care Registered Nurse
Primary
1255344
VA
163WX1500X
Ostomy Care Registered Nurse
1255344
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255344
HMO, PPO
VA
05
—
1255344
—
VA
Enumeration date
05/16/2020
Last updated
05/16/2020
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