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General NPI Number Information
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NPI Number | 1033109095
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Entity Type | Individual
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Provider Name | DANETTE T COLELLA
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Gender | Female
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 101 BOULDER POINT DR STE 1
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City | PLYMOUTH
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State | NH
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Zip | 03264-3170
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Country | US
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Telephone | 603-536-4000
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Fax | 603-536-4000
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Provider Business Mailing Address
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Address Line | 101 BOULDER POINT DR STE 1
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City | PLYMOUTH
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State | NH
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Zip | 03264-3170
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Country | US
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Telephone | 603-536-4000
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Fax | 603-536-4000
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 159758
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 64573
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 19572
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License Number State | NH
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