Healthcare Provider Details

I. General information

NPI: 1518531987
Provider Name (Legal Business Name): COLLEEN MEDLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 04/30/2024
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY MEDICAL ACTIVITY-BAVARIA UNIT 28038 ATTN: MCEU-BAV-CRE
APO AE
09112
US

IV. Provider business mailing address

US ARMY MEDICAL ACTIVITY-BAVARIA UNIT 28038 ATTN: MCEU-BAV-CRE
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number675793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: