Individual
COLLEEN NELL KOLPAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5501 OLD YORK RD, EMERGENCY DEPARTMENT, PHILADELPHIA, PA 19141-3018
(425) 753-3434
Mailing address
506 S 17TH ST, APT. B, PHILADELPHIA, PA 19146-1513
(425) 753-3434
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004272
IL
363A00000X
Physician Assistant
MA054155
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108878
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
—
Enumeration date
12/04/2009
Last updated
08/31/2017
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