Healthcare Provider Details

I. General information

NPI: 1245714120
Provider Name (Legal Business Name): MARYANN COLELLA LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/02/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 N. 5TH AVE STE 220
TUSCON AZ
85705
US

IV. Provider business mailing address

738 N. 5TH AVE STE 220
TUSCON AZ
85705
US

V. Phone/Fax

Practice location:
  • Phone: 520-640-4994
  • Fax: 520-844-6271
Mailing address:
  • Phone: 520-640-4994
  • Fax: 520-844-6271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number18080001
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: