Healthcare Provider Details

I. General information

NPI: 1376468397
Provider Name (Legal Business Name): DOMINIQUE COLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 MOSSWOOD DR
CONROE TX
77302-1170
US

IV. Provider business mailing address

643 MOSSWOOD DR
CONROE TX
77302-1170
US

V. Phone/Fax

Practice location:
  • Phone: 956-537-3867
  • Fax:
Mailing address:
  • Phone: 956-537-3867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number777363
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number777363
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: