Provider Demographics
NPI:1396998001
Name:FOREMAN, COLEEN (PAC)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2947
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2947
Mailing Address - Country:US
Mailing Address - Phone:509-248-7849
Mailing Address - Fax:509-248-8291
Practice Address - Street 1:3003 TIETON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3679
Practice Address - Country:US
Practice Address - Phone:509-454-2229
Practice Address - Fax:509-454-7979
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60051163363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical