Healthcare Provider Details

I. General information

NPI: 1033249511
Provider Name (Legal Business Name): MARY ELLEN COLE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N STATE ST
HEMET CA
92543-2960
US

IV. Provider business mailing address

3494 CATALINA AVE
HEMET CA
92545-6208
US

V. Phone/Fax

Practice location:
  • Phone: 951-791-3300
  • Fax: 951-791-3333
Mailing address:
  • Phone: 951-791-3312
  • Fax: 951-791-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR.N.492577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: