1962938753 NPI number — COLLEEN LYNN PRICE MSN, RN, APN

Table of content: COLLEEN LYNN PRICE MSN, RN, APN (NPI 1962938753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962938753 NPI number — COLLEEN LYNN PRICE MSN, RN, APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
COLLEEN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962938753
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1450 PARKSIDE AVE
Provider Second Line Business Mailing Address:
SUITE 21
Provider Business Mailing Address City Name:
EWING
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08638-2946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-403-6715
Provider Business Mailing Address Fax Number:
609-403-6567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 PARKSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE 21
Provider Business Practice Location Address City Name:
EWING
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08638-2946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-403-6715
Provider Business Practice Location Address Fax Number:
609-403-6567
Provider Enumeration Date:
05/11/2017

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: 363LA2100X , with the licence number:  26NJ00703200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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