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General NPI Number Information
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NPI Number | 1053803353
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Entity Type | Individual
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Provider Name | TARA IRENE COLELLA NIESEN NP
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Gender | Female
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 1330 POWELL ST STE 507
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City | NORRISTOWN
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State | PA
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Zip | 19401-3352
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Country | US
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Telephone | 484-622-7940
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Fax | 484-622-7950
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Provider Business Mailing Address
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Address Line | PO BOX 789967
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City | PHILADELPHIA
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State | PA
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Zip | 19178-9967
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Country | US
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Telephone | 484-622-7395
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Fax | 484-622-7399
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP018653
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License Number State | PA
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