Provider Demographics
NPI:1447667787
Name:COLEMAN, NANETTE ALANE (FNP-BC, CDE)
Entity type:Individual
Prefix:
First Name:NANETTE
Middle Name:ALANE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:FNP-BC, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 ALVARADO DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-6301
Mailing Address - Country:US
Mailing Address - Phone:314-922-8610
Mailing Address - Fax:
Practice Address - Street 1:4352 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2138
Practice Address - Country:US
Practice Address - Phone:314-531-5444
Practice Address - Fax:314-531-0063
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016690363LP2300X, 363LF0000X
KS537673062363LP2300X
IL277001410363LP2300X
IL209012593363LP2300X
MO2014024608363LP2300X, 363LF0000X
KS76737363LF0000X
OK205099363LF0000X, 363LP2300X
IAA165399363LF0000X, 363LP2300X
IL277.001410363LF0000X
WI11346-33363LF0000X
WI1134633363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily