Healthcare Provider Details

I. General information

NPI: 1609454883
Provider Name (Legal Business Name): COLLEEN ROSALIE HANEY AGNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SHAW AVE
HARRINGTON DE
19952-1220
US

IV. Provider business mailing address

201 SHAW AVE
HARRINGTON DE
19952-1220
US

V. Phone/Fax

Practice location:
  • Phone: 302-671-0176
  • Fax: 888-543-4267
Mailing address:
  • Phone: 302-671-0176
  • Fax: 888-543-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95017043
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0010801
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberLP-0010723
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: