Provider Demographics
NPI:1306351630
Name:COLEMAN, MOLLY JOANNA
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:JOANNA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:JOANNA
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:63 CARDINAL LANE
Mailing Address - City:GALLOPIS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25515
Mailing Address - Country:US
Mailing Address - Phone:304-356-4562
Mailing Address - Fax:304-558-4563
Practice Address - Street 1:63 CARDINAL LANE
Practice Address - Street 2:
Practice Address - City:GALLOPIS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25515
Practice Address - Country:US
Practice Address - Phone:304-356-4562
Practice Address - Fax:304-558-4563
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant