Individual
MS. COLLEEN RAE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN RNP CNM RN NP
Contact information
Practice address
2823 FRESNO ST, FRESNO, CA 93721-1324
(559) 499-6540
(559) 499-6541
Mailing address
2625 E DIVISADERO ST, FRESNO, CA 93721-1431
(559) 443-2682
(559) 443-2681
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
6558
CA
367A00000X
Advanced Practice Midwife
Primary
1129
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1129
NURSE MIDWIFE
CA
01
—
449993
REGISTERED NURSE
CA
01
—
6558
NURSE PRACTITIONER
CA
Enumeration date
11/23/2005
Last updated
12/29/2021
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