Provider Demographics
NPI:1346892213
Name:COLEMAN, LISA (NP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 MANGRUMS RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-8508
Mailing Address - Country:US
Mailing Address - Phone:434-228-9571
Mailing Address - Fax:
Practice Address - Street 1:2344 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4212
Practice Address - Country:US
Practice Address - Phone:540-769-3964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAF07190388207RC0200X
VA0024178030207RN0300X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner