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Individual

JACQUELINE ANNE COLLIGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2411 FOUNTAIN VIEW DR, SUITE 200, HOUSTON, TX 77057-4817
(713) 458-4185
Mailing address
2411 FOUNTAIN VIEW DR STE 200, HOUSTON, TX 77057-4832
(713) 620-4000

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
48234
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
002473901
TX
05
2117297
LA
01
430039901
RAILROAD MEDICARE
01
81171H
TX-BLUE SHIELD
Enumeration date
01/04/2007
Last updated
08/31/2010
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