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NPI Code Detail

MEDICARE: MRS. JEAN MARIE COLELLA ANP

MEDICARE: MRS. JEAN MARIE COLELLA ANP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN090566AZ
2363LA2200XAdult Health Nurse PractitionerAP1972AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AP1972OTHERAZAZ NP LIC

General Provider Information

NPI Number : 1902803208
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JEAN MARIE COLELLA ANP
Provider Business Mailing Address
First Line : PO BOX 10880
Second Line :
City : PRESCOTT
State : AZ
Zip : 86304-0880
Country : US
Telephone Number : 928-759-5987
Fax Number : 928-458-2039
Provider Business Practice Location Address
First Line : 1050 GAIL GARDNER WAY STE 300
Second Line :
City : PRESCOTT
State : AZ
Zip : 86305-1640
Country : US
Telephone Number : 928-717-5232
Fax Number : 928-717-5238
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 02/25/2019

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Directions to “ MRS. JEAN MARIE COLELLA ANP” Practice Location

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