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General NPI Number Information
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NPI Number | 1033302195
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Entity Type | Organization
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Legal Business Name | COLLEEN J. SPEIDELL NP PLC
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 01/22/2010
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Provider Practice Location Address
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Address Line | 2281 W 24TH ST STE 5
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City | YUMA
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State | AZ
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Zip | 85364-6197
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Country | US
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Telephone | 928-317-2707
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Fax | 928-317-3119
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Provider Business Mailing Address
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Address Line | PO BOX 672
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City | YUMA
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State | AZ
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Zip | 85366-0672
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Country | US
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Telephone | 928-317-2707
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Fax | 928-317-3119
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Authorized Official
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Title or Position | OWNER
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Name | COLLEEN J SPEIDELL
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Credential | N.P.
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Telephone | 928-317-2707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN084306
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License Number State | AZ
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