1841218047 NPI number — MS. COLETTE NICHOLE PESTER-PHILLIPS RD, LDN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841218047 NPI number — MS. COLETTE NICHOLE PESTER-PHILLIPS RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PESTER-PHILLIPS
Provider First Name:
COLETTE
Provider Middle Name:
NICHOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PESTER
Provider Other First Name:
COLETTE
Provider Other Middle Name:
NICHOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, LDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841218047
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 BUTTONWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNINGTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19335-4104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-241-2492
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 OLD LANCASTER RD STE 360
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYN MAWR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19010-3238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-380-2885
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  003476 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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