Healthcare Provider Details

I. General information

NPI: 1649634361
Provider Name (Legal Business Name): BRITTANY RENEE COLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 S MAIN ST
LAKEPORT CA
95453-5315
US

IV. Provider business mailing address

487 S MAIN ST
LAKEPORT CA
95453-5315
US

V. Phone/Fax

Practice location:
  • Phone: 707-263-4360
  • Fax: 707-263-4036
Mailing address:
  • Phone: 707-263-4360
  • Fax: 707-263-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC202283
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number83302
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: