Healthcare Provider Details

I. General information

NPI: 1356431050
Provider Name (Legal Business Name): COLLEEN K REILLY RN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PLAZA DR SUITE 402
SEWELL NJ
08080-2747
US

IV. Provider business mailing address

3 COOPER PLZ SUITE 502
CAMDEN NJ
08103-1438
US

V. Phone/Fax

Practice location:
  • Phone: 856-270-4040
  • Fax: 856-270-4044
Mailing address:
  • Phone: 856-968-7433
  • Fax: 856-968-8366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNR79808
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNN79808
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN322533L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: