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General NPI Number Information
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NPI Number | 1407911894
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Entity Type | Individual
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Provider Name | TERESA MCCOLLEY
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Gender | Female
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 3333 CHANATE RD
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City | SANTA ROSA
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State | CA
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Zip | 95404-1707
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Country | US
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Telephone | 707-565-4935
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 CHANATE RD
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City | SANTA ROSA
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State | CA
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Zip | 95404-1707
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Country | US
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Telephone |
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Fax |
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 598932
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 1758
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License Number State | CA
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