Provider Demographics
NPI:1285068627
Name:COLEMAN, ANGELA DAWN (MS,RD,LD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 BROOKSHIRE RUN
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-4153
Mailing Address - Country:US
Mailing Address - Phone:940-368-3343
Mailing Address - Fax:
Practice Address - Street 1:3402 BROOKSHIRE RUN
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-4153
Practice Address - Country:US
Practice Address - Phone:940-368-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDTO7491133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal