Healthcare Provider Details

I. General information

NPI: 1881807212
Provider Name (Legal Business Name): CONSTANCE ANN COLELLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CLARA MAASS DR
BELLEVILLE NJ
07109-3550
US

IV. Provider business mailing address

11 COBBLESTONE WAY
FAIRFIELD NJ
07004-3901
US

V. Phone/Fax

Practice location:
  • Phone: 973-450-2466
  • Fax: 973-844-4972
Mailing address:
  • Phone: 973-477-7307
  • Fax: 973-844-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number26NC07152000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: