Individual
COLLEEN M SLATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2331 FRANKLIN RD SW, ROANOKE, VA 24014-1111
(540) 224-5170
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001134247
VA
363LF0000X
Family Nurse Practitioner
Primary
0024168258
VA
363LF0000X
Family Nurse Practitioner
149755
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922246503
VA PREMIER
VA
05
—
1922246503
—
VA
01
—
541586601118
TRICARE/CHAMPUS
VA
01
—
P01051629
RAILROAD MEDICARE
VA
Enumeration date
02/04/2009
Last updated
07/24/2024
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