Healthcare Provider Details

I. General information

NPI: 1912066457
Provider Name (Legal Business Name): MARY ELIZABETH COLAGEO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 SCHOOL ST
SPRINGFIELD MA
01105-1301
US

IV. Provider business mailing address

92 MCBRIDE RD
MONSON MA
01057-9685
US

V. Phone/Fax

Practice location:
  • Phone: 413-846-4300
  • Fax:
Mailing address:
  • Phone: 413-267-9046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number136900PC
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: