1205471083 NPI number — SYLVIA COLEMAN AGPCNP-BC

Table of content: SYLVIA COLEMAN AGPCNP-BC (NPI 1205471083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205471083 NPI number — SYLVIA COLEMAN AGPCNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLEMAN
Provider First Name:
SYLVIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AGPCNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRYOR
Provider Other First Name:
SYLVIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AGPCNP-BC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205471083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2422 183RD ST APT 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMEWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60430-3129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 W KINZIE ST STE 17
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60654-6393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-776-2446
Provider Business Practice Location Address Fax Number:
312-776-2459
Provider Enumeration Date:
11/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  209020394 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 209020394 . This is a "ADULT GERONTOLOGY PRIMARY CARE NURSE PRACTITIONER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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