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General NPI Number Information
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NPI Number | 1508346800
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Entity Type | Individual
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Provider Name | COLLEEN BOTOS
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Gender | Female
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 5671 N SKEEL AVE STE 6
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City | OSCODA
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State | MI
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Zip | 48750-1535
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Country | US
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Telephone | 989-747-3036
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Fax | 989-747-3037
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Provider Business Mailing Address
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Address Line | 1335 KUNZE RD
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City | EAST TAWAS
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State | MI
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Zip | 48730-9597
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Country | US
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Telephone | 989-820-2881
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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 | 4704311007
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License Number State | MI
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