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NPI Code Detail

MEDICARE: FELICIA ANNE COLCLESSER NP

MEDICARE: FELICIA ANNE COLCLESSER NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner71001217BIN

General Provider Information

NPI Number : 1932325644
Entity Type Code : Individual
Provider Name (Legal Business Name) : FELICIA ANNE COLCLESSER NP
Provider Business Mailing Address
First Line : 4131 N WASHINGTON RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-1821
Country : US
Telephone Number : 260-436-7255
Fax Number :
Provider Business Practice Location Address
First Line : 5909 ILLINOIS RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-1159
Country : US
Telephone Number : 260-432-6026
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 07/08/2007

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