Individual
MRS. JEAN MARIE COLELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1050 GAIL GARDNER WAY STE 300, PRESCOTT, AZ 86305-1640
(928) 717-5232
(928) 717-5238
Mailing address
PO BOX 10880, PRESCOTT, AZ 86304-0880
(928) 759-5987
(928) 458-2039
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN090566
AZ
363LA2200X
Adult Health Nurse Practitioner
Primary
AP1972
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP1972
AZ NP LIC
AZ
Enumeration date
06/30/2005
Last updated
02/25/2019
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