Healthcare Provider Details

I. General information

NPI: 1447234190
Provider Name (Legal Business Name): COLLEEN J COLE DNP,APRN-BC, MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2749 FORT AMANDA RD
LIMA OH
45805-4805
US

IV. Provider business mailing address

2749 FORT AMANDA RD
LIMA OH
45805-4805
US

V. Phone/Fax

Practice location:
  • Phone: 419-226-9819
  • Fax: 567-202-8706
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6321
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6321
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.022600
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: